Ohio Administrative Code Search
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Rule 5160:1-2-10 | Medicaid: conditions of eligibility and verifications.
...enefits, social security disability insurance (SSDI), railroad retirement, and unemployment compensation. (c) When eligibility or ineligibility for other benefits cannot be verified electronically, an official letter from the paying entity or financial institution is sufficient to verify the benefit. (5) In accordance with 42 C.F.R. 435.610 (as in effect October 1, 2020) and section 5160.38 of t... |
Rule 5160:1-2-11 | Medicaid: United States (U.S.) citizenship documentation.
...eiving social security disability insurance (SSDI); or (iv) Receiving adoption or foster care assistance under Title IV-E of the Social Security Act (as in effect October 1, 2019); or (v) In foster care and receiving child welfare services under Title IV-B of the Social Security Act (as in effect October 1, 2019). (d) Other individuals on such other basis as the secretary of the d... |
Rule 5160:1-2-11 | Medicaid: United States (U.S.) citizenship documentation.
...eiving social security disability insurance (SSDI); or (iv) Receiving adoption or foster care assistance under Title IV-E of the Social Security Act (as in effect October 1, 2022); or (v) In foster care and receiving child welfare services under Title IV-B of the Social Security Act (as in effect October 1, 2022); or (vi) Receiving federal kinship guardianship assistance program... |
Rule 5160:1-3-02.2 | Medicare buy-in.
...y medicare part B (supplemental medical insurance) premiums for certain medicaid-eligible individuals even if those individuals are not eligible for a medicare premium assistance program (MPAP) set out in rule 5160:1-3-02.1 of the Administrative Code; and (2) The beginning date of payment of medicare part B (part B) benefits under this rule; and (3) The date and effect of termination of benefits... |
Rule 5160:1-3-02.6 | Medicaid: grandfathering provisions and deemed eligibility.
...in retirement, survivors and disability insurance (RSDI) as described in 42 C.F.R. 435.134 (as in effect October 1, 2019): individuals eligible despite the October 1972 twenty per cent general increase: (i) An individual who would currently be eligible for SSI or cash assistance except for the amount of increased income resulting from the October 1972 twenty per cent general increase in RSD... |
Rule 5160:1-3-03.1 | Medicaid: income.
...) 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 individual is not in... |
Rule 5160:1-3-03.2 | Medicaid: income exclusions.
...served in Vietnam. (q) Austrian social insurance payments based, in whole or in part, on wage credits received under the provisions of the Austrian General Social Insurance Act, paragraphs 500 to 506 (as in effect October 1, 2020). These payments are to be documented and identifiable from countable insurance. (r) Payments made to Native Americans as listed in section IV of 20 C.F.R. 416 subpart ... |
Rule 5160:1-3-05.1 | Medicaid: resource requirement.
..., jewelry, household goods, tools, life insurance policies, automobiles, promissory notes, etc. (6) "Real property" means land, including buildings or immovable objects, attached permanently to the land. (7) "Resources" is defined in rule 5160:1-1-01 of the Administrative Code. (8) "Resource limit" means the maximum combined value of all resources an individual can have an ownership interest in and still qualify f... |
Rule 5160:1-3-05.1 | Medicaid: resource requirement.
..., jewelry, household goods, tools, life insurance policies, automobiles, promissory notes, etc. (7) "Real property" means land, including buildings or immovable objects, attached permanently to the land. (8) "Resources" is defined in rule 5160:1-1-01 of the Administrative Code. (9) "Resource limit" means the maximum combined value of all resources an individual can have an ownership interes... |
Rule 5160:1-3-05.6 | Medicaid: burial funds and contracts.
...purchase price has been paid. (G) Life insurance funded burial contracts. (1) A life insurance funded burial contract involves an individual owning/purchasing a life insurance policy on his or her own life and then assigning, revocably or irrevocably, either the ownership or proceeds of the policy to a third party, generally a funeral provider. The purpose of the assignment is to fund a burial contract. (a) Assign... |
Rule 5160:1-3-05.8 | Medicaid: lump-sum payments.
...ceived as the beneficiary of a life insurance policy, including social security lump-sum death benefits. (5) Workers compensation payments when received as a lump-sum. (D) An unanticipated nonrecurring lump-sum payment is not considered unearned income in the month of receipt and is a resource in the month following the month of receipt. The following are some types of unanticipated lump-sum... |
Rule 5160:1-3-05.11 | Medicaid: automobiles and other modes of transportation as resources.
...ar or truck dealer or an automobile insurance company. The administrative agency is not bound by this appraisal but the appraisal is to be considered in the evaluation of the vehicle. (3) Always verify the collector value of an antique or other collectible vehicle. |
Rule 5160:1-3-05.12 | Medicaid: life insurance.
...(A) This rule describes how life insurance policies are treated for purposes of determining medical assistance eligibility. (B) Definitions of terms contained within life insurance policies. (1) "Accelerated life insurance payments" means some or all of the proceeds from the life insurance policy are paid out to the policy owner prior to the death of the insured. (2) "Beneficiary" means an individual or entity nam... |
Rule 5160:1-3-05.14 | Medicaid: resource exclusions.
.... L. No. 101-426). (f) Austrian social insurance payments, based in whole or in part, on wage credits paid under paragraphs 500 to 506 of the Austrian General Social Insurance Act (as in effect October 1, 2020). (g) Payments received from the Dutch government as a result of the Netherlands' Benefit Act for victims of persecution from 1940-1945 (Dutch acronym, WUV) (Pub. L. No. 103-286). (h) Payment... |
Rule 5160:1-4-01 | MAGI-based medicaid: household composition and income.
...ith children who do not have health insurance coverage and who is working with a grantee organization under section 2113 of the Social Security Act (as in effect October 1, 2020), are excluded as income under the Helping Ensure Access for Little ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable (HEALTHY KIDS) Act (Pub. L. No. 115-120). (6) Alimony payments. (a) Alimony payme... |
Rule 5160:1-5-02.1 | Medicaid: breast and cervical cancer project (BCCP) definitions.
...idered creditable coverage: (i) Health insurance benefits consisting of medical care (provided directly, through insurance or reimbursement, or otherwise and including items and services paid for as medical care) under any hospital or medical service policy or certificate, hospital or medical service plan contract; (ii) Health maintenance organization contract offered by a health insur... |
Rule 5160:1-5-03 | Medicaid: medicaid buy-in for workers with disabilities (MBIWD).
...r source, such as medicaid, private insurance, or an employer. (12) "Medical insurance premiums" means the amount paid for insurance coverage for medical items or services such as health, dental, vision, long-term care, hospital, prescriptions, etc. (13) "Medically improved covered group" means the individuals meeting all criteria in paragraph (C)(2) of this rule. (14) "Premium" means a per... |
Rule 5160:1-5-05 | Medicaid: refugee medical assistance (RMA).
...ual or family member. (9) "Medical insurance premiums" means the amount paid for insurance coverage for medical items or services such as health, dental, vision, long-term care, hospital, prescriptions, etc. (10) "Medically necessary" has the same meaning as in rule 5160-1-01 of the Administrative Code. (a) Medical insurance premiums as defined in paragraph (B)(9) of this rule are always c... |
Rule 5160:1-5-07 | Medicaid: specialized recovery services (SRS) program.
...(SSI) or social security disability insurance (SSDI) benefits. (a) A disability determination is not required for individuals over the age of sixty-five years old who are active on the solid organ or soft tissue waiting list, or who have certain diagnosed chronic conditions. (b) A disability determination is not required for individuals under age sixty-five years old who are enrolled in the medi... |
Rule 5160:1-6-02 | Medicaid: special resource rules when an individual is requesting or receiving medicaid payment for long-term care (LTC) services.
...luation of any qualified long-term care insurance policy as described in rule 5160:1-6-02.2 of the Administrative Code. (3) Evaluation of any entrance fee when the individual is residing in a continuing care retirement community, life care community, or a philanthropic long-term care facility as described in rule 5160:1-6-02.3 of the Administrative Code. |
Rule 5160:1-6-02.2 | Medicaid: treatment of qualified long-term care insurance policies.
...at estate recovery in the amount of insurance benefit payments made to or on behalf of the individual who is a beneficiary of a QLTCP policy. (C) A QLTCP policy is one that meets all of the following requirements: (1) On the date the policy was issued, the state in which the insured resided had in place an approved state plan amendment which provides, pursuant to 42 U.S.C. 1396p(b) (as in ef... |
Rule 5160:1-6-03.1 | Medicaid: determining financial eligibility for medical assistance using the special income level.
...an reparation payments, Austrian social insurance payments, and Netherlands reparation payments, in accordance with the Nazi Persecution Victims Eligibility Act, Pub. L. No. 103-286 or provisions of the Austrian General Social Insurance Act, paragraphs 500 through 506 (as in effect October 1, 2019). (c) Japanese and Aleutian restitution payments, under the provisions of section 105 of Pub. L. No.... |
Rule 5160:1-6-03.1 | Medicaid: determining financial eligibility for medical assistance using the special income level.
... Nazi persecution. (c) Austrian social insurance payments based, in whole or in part, on wage credits received under the provisions of the Austrian General Social Insurance Act, paragraphs 500 through 506 (as in effect October 1, 2022). These payments need to be documented and identifiable separate from countable insurance. (d) Payments from the Dutch government under the Netherlands' Benefit Ac... |
Rule 5160:1-6-07 | Medicaid: post-eligibility treatment of income for individuals in medical institutions.
...an reparation payments, Austrian social insurance payments, and Netherlands reparation payments, in accordance with the Nazi Persecution Victims Eligibility Act, Pub. L. No. 103-286 or provisions of the Austrian General Social Insurance Act, paragraphs 500 through 506 (as in effect October 1, 2016). (b) Japanese and Aleutian restitution payments, under the provisions of section 105 of Pub. L. No. 100-383 (as in effe... |
Rule 5160:1-6-07 | Medicaid: post-eligibility treatment of income for individuals in medical institutions.
... Nazi persecution. (b) Austrian social insurance payments based, in whole or in part, on wage credits received under the provisions of the Austrian General Social Insurance Act, paragraphs 500 through 506 (as in effect on October 1, 2022). These payments need to be documented and identifiable separate from countable insurance. (c) Payments from the Dutch government under the Netherlands' Benefit... |