Ohio Administrative Code Search
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Rule 5160:1-3-02 | Medicaid: criteria for age, blindness, or disability.
... physical factors of age, blindness, or 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 Admi... |
Rule 5160:1-3-02.1 | Medicare premium assistance programs (MPAP).
...y-five years of age; and (ii) Has lost disability benefits under Title II of the Social Security Act (as in effect October 1, 2019) solely due to earnings in excess of the substantial gainful activity (SGA) level established by the SSA; and (iii) Is paying a premium for part A coverage; and (iv) Has provided no document or communication from the SSA indicating another basis for part A... |
Rule 5160:1-3-02.1 | Medicare premium assistance programs (MPAP).
...y-five years of age; and (ii) Has lost disability benefits under Title II of the Social Security Act (as in effect October 1, 2023) solely due to earnings in excess of the substantial gainful activity (SGA) level established by the SSA; and (iii) Is paying a premium for part A coverage; and (iv) Has provided no document or communication from the SSA indicating another basis for part A... |
Rule 5160:1-3-02.4 | Medicaid: coverage for the categorically needy.
...(2) Determinations of blindness and disability must be in accordance with SSA policy; (3) Have countable income, as determined under Chapter 5160:1-3 of the Administrative Code, which does not exceed the income standard described in rule 5160:1-3-03.5 of the Administrative Code; (4) Have countable resources, as determined under Chapter 5160:1-3 of the Administrative Code, which do not exceed... |
Rule 5160:1-3-02.4 | Medicaid: coverage for the categorically needy.
...(2) Determinations of blindness and disability must be in accordance with SSA policy; and (3) Have countable income, as determined under Chapter 5160:1-3 of the Administrative Code, which does not exceed the income standard described in rule 5160:1-3-03.5 of the Administrative Code; and (4) Have countable resources, as determined under Chapter 5160:1-3 of the Administrative Code, which do no... |
Rule 5160:1-3-02.6 | Medicaid: grandfathering provisions and deemed eligibility.
... met the definition of blindness or disability in effect under the former programs of AFB or AFD and meets the following criteria: (i) The individual meets all current requirements for medicaid eligibility except for blindness or disability; and (ii) The individual was eligible for medicaid in December 1973 as blind or disabled, whether or not the individual received cash assistance in Dec... |
Rule 5160:1-3-02.6 | Medicaid: grandfathering provisions and deemed eligibility.
... met the definition of blindness or disability in effect under the former programs of AFB or AFD and meets all of the following criteria: (i) The individual meets all current requirements for medicaid eligibility except for blindness or disability; (ii) The individual was eligible for medicaid in December 1973 as blind or disabled, whether or not the individual received cash assistance in ... |
Rule 5160:1-3-02.9 | Medicaid: disability determination process.
...process of determining blindness or disability for medical assistance eligibility 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 ... |
Rule 5160:1-3-02.9 | Medicaid: disability determination process.
...process of determining blindness or disability for non-citizen emergency medical assistance (NCEMA), medicaid buy-in for workers with disabilities (MBIWD), retroactive coverage for a deceased individual, or the specialized recovery services (SRS) program. (B) Definitions. (1) "Administrative agency," for the purpose of this rule, means the county department of job and family services (CDJFS)... |
Rule 5160:1-3-02.9 | Medicaid: disability determination process.
...process of determining blindness or disability for non-citizen emergency medical assistance (NCEMA), medicaid buy-in for workers with disabilities (MBIWD), Ohio workability, retroactive coverage for a deceased individual, or the specialized recovery services (SRS) program. (B) Definitions. (1) "Administrative agency," for the purpose of this rule, means the county department of job and famil... |
Rule 5160:1-3-03.1 | Medicaid: income.
...ted to: (1) Retirement, survivors, disability insurance (RSDI); (2) Prouty benefits; (3) Railroad retirement; (4) Veterans benefits; (5) Other public/private retirement benefits; (E) The following items are not considered income, in accordance with 20 C.F.R. 416.1103 (as in effect October 1, 2019). This list is not all inclusive: (1) A personal service performed for an individua... |
Rule 5160:1-3-03.1 | Medicaid: income.
...ted to: (1) Retirement, survivors, disability insurance (RSDI); or (2) Prouty benefits; or (3) Railroad retirement; or (4) Veterans benefits; or (5) Other public/private retirement benefits. (E) The following items are not considered income, in accordance with 20 C.F.R. 416.1103 (as in effect October 1, 2023). This list is not all-inclusive: (1) A personal service performed for ... |
Rule 5160:1-3-03.2 | Medicaid: income exclusions.
...of age or marital status, for any disability resulting from spina bifida suffered by such children; and (ii) Certain Korea service veterans' natural children, regardless of age or marital status, for any disability resulting from spina bifida suffered by such children; and (iii) The natural children, regardless of age or marital status, with certain birth defects born to a ... |
Rule 5160:1-3-03.3 | Medicaid: deeming of income.
...le spouse or ineligible parent receives disability benefits under title II of the act; (24) Interest earned on excluded burial funds and appreciation in the value of excluded burial arrangements which are left to accumulate and become part of separate burial funds, and interest accrued on and left to accumulate as part of the value of agreements representing the purchase of excluded burial spaces... |
Rule 5160:1-3-03.7 | Medicaid: treatment of sick pay and sick leave.
... third party for sickness or accident disability. (2) "Sick leave" means a paid absence from duty for personal or family medical reasons and considered a continuation of salary. (C) Treatment of sick pay. (1) Sick pay is treated as earned income (wages) if the individual receives sick pay within six months after stopping work and the income is not attributable to the employee's own contributi... |
Rule 5160:1-3-03.7 | Medicaid: treatment of sick pay and sick leave.
...te third party for sickness or accident disability. (2) "Sick leave" means a paid absence from duty for personal or family medical reasons and is considered a continuation of salary. (C) Treatment of sick pay. (1) Sick pay is treated as earned income (wages) when the individual receives sick pay within six months after stopping work and the income is not attributable to the employee's own contributions toward a si... |
Rule 5160:1-3-03.10 | Medicaid: retirement funds.
...h plans as: public and private pension, disability, or retirement plans; defined benefit employer pension plans, profit sharing pension plans, 403(b) pension plans, money purchase pension plans, employee stock ownership plans, individual retirement accounts (IRA); KEOGH pension plans, Roth IRAs, simplified employee pension plans (SEP-IRA), and 401k pension plans; or any other pension or retirement... |
Rule 5160:1-3-05.8 | Medicaid: lump-sum payments.
...ome (SSI) or retirement, survivors, disability insurance (RSDI) are unearned income in the month received and excluded as countable resources for nine months following the month of receipt. The source, amount, and the date of receipt of the retroactive payment must be verified and the information recorded in the case record. (1) As long as the funds from the retroactive payment are not spent,... |
Rule 5160:1-3-05.8 | Medicaid: lump-sum payments.
...ome (SSI) or retirement, survivors, disability insurance (RSDI) are unearned income in the month received and excluded as countable resources for nine months following the month of receipt. The source, amount, and the date of receipt of the retroactive payment must be verified and the information recorded in the case record. (1) As long as the funds from the retroactive payment are not spent,... |
Rule 5160:1-3-05.14 | Medicaid: resource exclusions.
...of age or marital status, for any disability resulting from spina bifida suffered by such children; and (ii) Certain Korea service veterans' natural children, regardless of age or marital status, for any disability resulting from spina bifida suffered by such children; and (iii) The natural children, regardless of age or marital status, with certain birth defects born to a ... |
Rule 5160:1-4-01 | MAGI-based medicaid: household composition and income.
... on the basis of age, blindness, or disability, or which only cover an individual's medicare premium or cost-sharing. (B) Definition. "Person" for the purpose of this rule, means someone in the family or household of an individual applying for or receiving medical assistance. (C) Determining household composition and family size. (1) For the tax year in which the eligibility determination i... |
Rule 5160:1-5-03 | Medicaid: medicaid buy-in for workers with disabilities (MBIWD).
...ndividual with a medically improved disability" means an individual who is a recipient of MBIWD in the basic covered group but who no longer meets the disability criterion as defined in paragraph (C)(1)(b) of this rule. (10) "Medicaid buy-in for workers with disabilities (MBIWD)" means the component of the medicaid program established under sections 5163.09 to 5163.098 of the Revised Code and inc... |
Rule 5160:1-5-03 | Medicaid: medicaid buy-in for workers with disabilities (MBIWD).
...ndividual with a medically improved disability" means an individual who is a recipient of MBIWD in the basic covered group but who no longer meets the disability criterion as defined in paragraph (C)(1)(b) of this rule. (10) "Medicaid buy-in for workers with disabilities (MBIWD)" means the component of the medicaid program established under sections 5163.09 to 5163.098 of the Revised Code and inc... |
Rule 5160:1-5-04 | Medicaid: Ohio workability.
...ar 2025. (13) "Social security disability insurance (SSDI)" means the program established under Title II of the Social Security Act (as in effect October 1, 2024). (14) "Supplemental security income (SSI)" means the program established under Title XVI of the Social Security Act (as in effect October 1, 2024). (15) "Work" or "working," for the purpose of this rule, means employment or ... |
Rule 5160:1-5-04 | Medicaid: Ohio workability.
...ar 2025. (13) "Social security disability insurance (SSDI)" means the program established under Title II of the Social Security Act (as in effect October 1, 2024). (14) "Supplemental security income (SSI)" means the program established under Title XVI of the Social Security Act (as in effect October 1, 2024). (15) "Work" or "working," for the purpose of this rule, means employment or ... |