Ohio Administrative Code Search

...riteria for presumptive coverage. (1) Except as set forth in paragraph (B)(2) of this rule, an individual is eligible for presumptive coverage when the individual: (a) Is a resident of the state of Ohio; and (b) Is a U.S. citizen or has an immigration status as defined in rule 5160:1-2-12 of the Administrative Code that allows for medicaid eligibility; and (c) Meets the non-financial eligibili...

...nth period, as described in section 1902(e)(12) of the Social Security Act (as in effect October 1, 2019). (B) Eligibility criteria. A child remains eligible for coverage despite changes in the child's circumstances for a period of twelve months if the child was found to be eligible for a category of medical assistance other than: (1) Presumptive eligibility as described in Chapter 5160:1-1 ...

...nth period, as described in section 1902(e)(12) of the Social Security Act (as in effect October 1, 2023). (B) Eligibility criteria. A child remains eligible for coverage despite changes in the child's circumstances for a period of twelve months when the child was found to be eligible for a category of medical assistance other than: (1) Presumptive eligibility as described in rule 5160:1-2-1...

...ng terms have the following meanings: (1) "Healthchek" is Ohio's early and periodic screening, diagnostic and treatment benefit for all medicaid eligible individuals under twenty-one years of age. (2) "Healthchek coordinator" is the CDJFS employee who is responsible for the implementation of healthchek services. (3) "Healthchek services" are periodic screening services (including a comprehensiv...

... of age who is enrolled in medicaid. (1) The healthchek benefit provides comprehensive preventative, diagnostic, and treatment services for an eligible individual as specified in Section 1905(r) of the Social Security Act (as in effect October 1, 2024). (2) There is no separate enrollment for healthchek. When an individual is eligible for medical assistance and is under twenty-one years of age,...

...comes in accordance with 42 C.F.R. 440.210 (as in effect January 1, 2014). (B) Definitions. (1) "Individual" for the purpose of this rule, means a medicaid-eligible individual who is pregnant, as verified by either self-declaration or medical verification, including the sixty days post-partum period. (2) ODM 03515 "Pregnancy Related Services Implementation Plan" (PRSIP) (rev. 1/2015) means the document submitted b...

...comes in accordance with 42 C.F.R. 440.210 (as in effect October 1, 2023). (B) Definitions. (1) "Administrative agency," for the purpose of this rule, means the county department of job and family services (CDJFS). (2) "Individual" for the purpose of this rule, means a pregnant woman eligible for medical assistance, as verified by either self-declaration or medical verification, including d...

...sability status as set forth in section 1902 of the Social Security Act (as in effect on February 1, 2016). The provisions of Chapter 5160:1-3 of the Administrative Code establish eligibility criteria, standards, and procedures that apply to individuals enrolling in an aged, blind or disability categorical coverage group. (B) The rules of this chapter are organized as follows: (1) Rules under pr...

... requirements as set forth in section 1902 of the Social Security Act (as in effect October 1, 2022). The provisions of Chapter 5160:1-3 of the Administrative Code establish eligibility criteria, standards, and procedures that apply to individuals enrolling in an aged, blind, or disabled categorical coverage group. (B) The rules of this chapter are organized as follows: (1) Rules under princip...

..., or disability as set forth in section 1902 of the Social Security Act (as in effect on October 1, 2016). Age is determined by county departments of job and family services (CDJFS). Blindness and disability are determined by either the social security administration (SSA) or the Ohio department of medicaid (ODM) in accordance with rule 5160:1-3-02.9 of the Administrative Code. The criteria are as follows: (1) Age: ...

... disability as set forth in section 1902 of the Social Security Act (as in effect on October 1, 2024). Age is determined by county departments of job and family services (CDJFSs). Blindness and disability are determined by either the social security administration (SSA) or the Ohio department of medicaid (ODM) in accordance with rule 5160:1-3-02.9 of the Administrative Code. (B) The criteria for ...

...ciary (SLMB), qualified individuals (QI-1), and qualified disabled and working individuals (QDWI). (B) Definitions. (1) "Eligible," for the purpose of this rule, means an individual meets all the requirements to enroll in MPAP. (2) "Enrolled," for the purpose of this rule, means an individual is in receipt of benefits under a medicare health plan. (3) "Entitled" for the purpose of this rul...

...iciary (SLMB), qualified individual (QI-1), and qualified disabled and working individual (QDWI). (B) Definitions. (1) "Eligible," for the purpose of this rule, means an individual meets all the requirements to enroll in MPAP. (2) "Enrolled," for the purpose of this rule, means an individual is in receipt of benefits under a medicare health plan. (3) "Entitled," for the purpose of this rul...

...(A) This rule sets forth: (1) The eligibility criteria for benefits under the medicare part B buy-in agreement between the social security administration (SSA) and the Ohio department of medicaid (ODM), which allows ODM to pay medicare part B (supplemental medical insurance) premiums for certain medicaid-eligible individuals even if those individuals are not eligible for a medicare premium assist...

...(A) This rule sets forth: (1) The eligibility criteria for benefits under the medicare part B (part B) buy-in agreement between the social security administration (SSA) and the Ohio department of medicaid (ODM), which allows ODM to pay part B (supplemental medical insurance) premiums for certain individuals even when those individuals are not eligible for a medicare premium assistance program (MP...

...l Security Act (as in effect on October 1, 2017). Eligibility for this category shall be determined for applications for medical assistance filed on or after August 1, 2016. (B) Eligibility criteria. To be eligible for coverage under this group an individual must be receiving SSI benefits based on the social security administration's determination of eligibility for SSI payments. In addition, cer...

...cial Security Act (as in effect October 1, 2023). (B) Eligibility criteria. To be eligible for coverage under this group an individual must be receiving SSI benefits based on the social security administration's determination of eligibility for SSI payments. In addition, certain requirements specific to medical assistance must be met in order for an individual to be eligible under this group. Fai...

...urity Act (as in effect on February 1, 2016) but do not receive cash benefits under the program. Eligibility for this program shall be determined for applications for medical assistance filed on or after the effective date of this rule. (B) Eligibility criteria. To be eligible under this group, an individual must meet all of the following critiera: (1) Be aged, blind or disabled; (2) De...

... Security Act (as in effect October 1, 2022) but who do not receive cash benefits under the program. Eligibility for this program shall be determined for applications for medical assistance filed on or after the August 1, 2016 effective date of this rule. (B) Eligibility criteria. To be eligible under this group, an individual must meet all of the following critiera: (1) Be aged, blind, or ...

... receving SSI benefits under section 1619 of the Social Security Act. (B) Section 1619 of the Social Security Act (as in effect October 1, 2022) comprises two basic provisions: (1) Section 1619(a) extends special SSI cash to individuals whose earnings preclude eligibility for regular SSI cash benefits. Individuals in 1619(a) status may still receive an SSI cash benefit in addition to the indi...

...as implemented. (B) Definitions. (1) "Cash assistance," for the purpose of this rule, means the receipt of at least one of the following: Ohio works first (OWF), SSI or residential state supplement (RSS), or the former programs of aid known as aid for dependent children (ADC), aid for the aged (AFA), aid for the blind (AFB), and aid for the disabled (AFD). (2) "Essential spouse" for the...

...as implemented. (B) Definitions. (1) "Cash assistance," for the purpose of this rule, means the receipt of at least one of the following: Ohio works first (OWF), SSI, residential state supplement (RSS), or the former programs of aid known as aid for dependent children (ADC), aid for the aged (AFA), aid for the blind (AFB), and aid for the disabled (AFD). (2) "Essential spouse," for the ...

...ility purposes. (B) Definitions. (1) "Administrative agency," for the purpose of this rule, means the county department of job and family services (CDJFS). (2) "Current medical information" means medical records that originated within eighteen months of the date of initial application. (3) "Deferred" means the delay in the determination for a disability packet due to incomplete or a in...

...ices (SRS) program. (B) Definitions. (1) "Administrative agency," for the purpose of this rule, means the county department of job and family services (CDJFS). (2) "Current medical information" means medical records that originated within eighteen months of the date of initial application. (3) "Deferred" means the delay in the determination for a disability packet due to incomplete or an i...

...bes how income, as defined in rule 5160:1-1-01 of the Administrative Code, is treated for the purpose of determining eligibility for medical assistance for aged, blind, or disabled individuals. (B) Treatment of income. (1) Eligibility for medical assistance is dependent in part upon the amount of monthly income available to or received by the individual. (a) Gross income, prior to any deductio...