Ohio Administrative Code Search

...(A) This rule describes section 1903(r)(3) of the Social Security Act (as in effect October 1, 2019) and paragraph (d) of 42 C.F.R 435.945 (as in effect October 1, 2019), that each medicaid state agency have an eligibility determination system which provides for data matching through the public assistance reporting information system (PARIS). (B) Definition. "PARIS" is a system for matching d...

...(A) This rule describes section 1903(r)(3) of the Social Security Act (as in effect October 1, 2024) and paragraph (d) of 42 C.F.R 435.945 (as in effect October 1, 2024), that each medicaid state agency have an eligibility determination system which provides for data matching through the public assistance reporting information system (PARIS). (B) Definition. "PARIS" is a system for matching d...

...(A) This rule describes the responsibilities of the administrative agency. (B) Calculation of time periods for eligibility determinations. All calculations of time periods used in the determination of eligibility, including an annual renewal or a redetermination as a result of a reported change, shall be computed as follows: (1) When counting the number of days in a specified time period, the in...

...(A) This rule describes the responsibilities of the administrative agency. (B) Calculation of time periods for eligibility determinations. All calculations of time periods used in the determination of eligibility, including an annual renewal or a redetermination as a result of a reported change, shall be computed as follows: (1) When counting the number of days in a specified time period, the in...

...(A) This rule sets out requirements for the administrative agency to identify and refer consumer fraud and erroneous payments made on behalf of an individual by medicaid. (B) Investigation of complaints. Upon notification of a complaint of medicaid fraud, abuse or questionable practices, the administrative agency must conduct a preliminary investigation in accordance with 42 C.F.R. 455.14 (as in ...

...(A) This rule describes Ohio's medicaid estate recovery program and the undue hardship waiver request process. (B) Definitions. (1) "Estate" includes both of the following: (a) All real and personal property and other assets to be administered under Title XXI of the Revised Code and property that would be administered under that title if not for section 2113.03 or 2113.031 of the Revised Co...

...(A) This rule describes the responsibilities of an individual, or someone acting on his or her behalf, who is applying for or receiving medical assistance. (B) Individual responsibilities. (1) When applying for or receiving any medical assistance, an individual must: (a) Sign, under penalty of perjury, and submit an application for medical assistance. The individual's signature may be written (...

...(A) This rule describes the responsibilities of an individual, or someone acting on an individual's behalf, who is applying for or receiving medical assistance. (B) Individual responsibilities. (1) When applying for or receiving any medical assistance, an individual must: (a) Sign, under penalty of perjury, and submit an application for medical assistance in accordance with rule 5160:1-2-01 of ...

...(A) This rule describes eligibility criteria that apply to all medical assistance programs, how eligibility criteria will be verified by the administrative agency, and when an individual will be asked to provide manual verification. Eligibility conditions that are specific to a certain eligibility group are addressed in the eligibility rule for that group. (B) To be determined eligible for medica...

...(A) This rule describes eligibility criteria that apply to all medical assistance programs, how eligibility criteria will be verified by the administrative agency, and when an individual will be asked to provide manual verification. Eligibility conditions that are specific to a certain eligibility group are addressed in the eligibility rule for that group. (B) To be determined eligible for medica...

...(A) This rule sets forth acceptable documentary evidence of United States (U.S.) citizenship and the circumstances under which an individual who declares U.S. citizenship, under penalty of perjury, may be given a reasonable opportunity to verify U.S. citizenship. (B) Any individual applying for medical assistance and declaring U.S. citizenship or nationality shall verify citizenship in accord...

...(A) This rule sets forth acceptable documentary evidence of United States (U.S.) citizenship and the circumstances under which an individual who declares U.S. citizenship, under penalty of perjury, may be given a reasonable opportunity to verify U.S. citizenship. (B) Any individual applying for medical assistance and declaring U.S. citizenship or nationality shall verify citizenship in accord...

...(A) This rule sets forth acceptable documentary evidence of U.S. citizenship and the circumstances under which an individual who declares U.S. citizenship, under penalty of perjury, may be given a reasonable opportunity to verify U.S. citizenship. (B) Definition."National of the U.S." for the purpose of this rule, means an individual who is not a U.S. citizen, but owes permanent allegiance to the U.S. as defined in ...

...(A) This rule sets forth: (1) Medical assistance eligibility criteria for an individual who is not a U.S. citizen or national; and (2) Acceptable documentary evidence of qualified non-citizen status; and (3) The circumstances under which an individual who declares qualified non-citizen status, under penalty of perjury, may be given a reasonable opportunity to verify that status. (B) Defin...

...(A) This rule sets forth: (1) Medical assistance eligibility criteria for an individual who is not a United States (U.S.) citizen or a national of the U.S.; (2) Acceptable documentary evidence of qualified non-citizen status; and (3) The circumstances under which an individual who declares qualified non-citizen status, under penalty of perjury, may be given a reasonable opportunity to verify that status. (B) Def...

...(A) This rule describes the requirement to deem income and resources from a sponsor to a non-citizen, exemptions from the sponsor deeming requirement, and the process for calculating the amount of income and resources to deem. (1) In accordance with 8 U.S.C. 1182 (as in effect October 1, 2024), certain non-citizens seeking lawful permanent resident (LPR) status are required to provide an affidavit of support from a ...

...(A) This rule describes the twelve-month period of continuous eligibility for a child younger than age nineteen, and the conditions under which the child's coverage ends during the twelve-month 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 circums...

...(A) This rule describes the twelve-month period of continuous eligibility for a child younger than age nineteen, and the conditions under which the child's coverage ends during the twelve-month 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 circums...

...(A) The purpose of this rule is to explain the requirements of healthchek, Ohio's early and periodic screening, diagnostic and treatment (EPSDT) benefit that all medicaid eligible individuals under twenty-one years of age are entitled to receive. A separate healthchek application is not required. Each county department of job and family services (CDJFS) is required to have a healthchek coordin...

...(A) This rule explains the requirements of healthchek, Ohio's early and periodic screening, diagnostic and treatment (EPSDT) benefit that is mandatory for an individual under twenty-one years 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 Socia...

...(A) The purpose of this rule is to outline the responsibilities of the administrative agency to inform medicaid-eligible pregnant women about the benefits and importance of pregnancy related services (PRS), to make requested or needed referrals to support services, and to provide non-medical services promoting healthy birth outcomes in accordance with 42 C.F.R. 440.210 (as in effect January 1, 2014). (B) Definitions...

...(A) The purpose of this rule is to outline the responsibilities of the administrative agency to inform a pregnant woman eligible for medical assistance about the benefits and importance of pregnancy related services (PRS), to make requested or needed referrals to support services, and to provide non-medical support services that promote healthy birth outcomes in accordance with 42 C.F.R. 440.210 (...

...(A) The medicaid program provides coverage for individuals who meet the aged, blind, or disability 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 co...

...(A) The medicaid program provides coverage for individuals who meet the aged, blind, or disability status 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 catego...

...(A) The medicaid program provides coverage for individuals who have been determined to meet the criteria for the limiting physical factors of age, blindness, 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 administrat...