Ohio Revised Code Search

...e percentage for medical assistance provided to members of the expansion eligibility group is set below ninety per cent, the department of medicaid shall do both of the following: (1) Immediately discontinue all medical assistance for members of the group. (2) Not later than fifteen business days after the change to the federal medical assistance percentage, certify to the director of budget and management, legis...

...The medicaid program's eligibility requirements for aged, blind, and disabled individuals may be more restrictive than the eligibility requirements for the supplemental security income program. Any such more restrictive eligibility requirements shall be consistent with the 209(b) option described in the "Social Security Act," section 1902(f), 42 U.S.C. 1396a(f).

...The medicaid program shall cover all of the following optional eligibility groups: (A) The group consisting of children placed with adoptive parents who are specified in section 1902(a)(10)(A)(ii)(VIII) of the "Social Security Act," 42 U.S.C. 1396a(a)(10)(A)(ii)(VIII); (B) Subject to section 5163.061 of the Revised Code, the group consisting of women during pregnancy and the maximum postpartum period permitted ...

... pregnancy who are covered by the medicaid program under division (B) of section 5163.06 of the Revised Code.

...The medicaid director shall adopt rules under section 5163.02 of the Revised Code as necessary to provide medicaid coverage for the optional eligibility group described in section 1902(a)(10)(A)(ii)(XIII) of the "Social Security Act," 42 U.S.C. 1396a(a)(10)(A)(ii)(XIII). By requiring the medicaid program to provide coverage to the optional eligibility group consisting of employed individuals with disabilities unde...

...The medicaid director shall implement the option authorized by the "Social Security Act," section 1931(b)(2)(C), 42 U.S.C. 1396u-1(b)(2)(C), to set the income eligibility threshold at ninety per cent of the federal poverty line for parents and caretaker relatives who are covered by the medicaid program under that section of the "Social Security Act."

...vised Code: "Applicant" means an individual who applies to participate in the medicaid buy-in for workers with disabilities program. "Earned income" has the meaning established by rules authorized by section 5163.098 of the Revised Code. "Employed individual with a medically improved disability" has the same meaning as in the "Social Security Act," section 1905(v), 42 U.S.C. 1396d(v). "Family" means an appli...

...Under the medicaid buy-in for workers with disabilities program, an individual who does all of the following in accordance with rules authorized by section 5163.098 of the Revised Code qualifies for the medicaid program: (A) Applies for the medicaid buy-in for workers with disabilities program; (B) Provides satisfactory evidence of all of the following: (1) That the individual is at least sixteen years of age...

...(A) Except as provided in division (B) of this section, the maximum value of resources, less amounts disregarded pursuant to rules authorized by section 5163.098 of the Revised Code, that an individual may have without the individual exceeding the resource eligibility limit for the medicaid buy-in for workers with disabilities program shall not exceed ten thousand dollars. (B) Each calendar year, the medicaid...

...purpose of determining whether an individual is within the income eligibility limit for the medicaid buy-in for workers with disabilities program, all of the following apply: (A) Twenty thousand dollars of the individual's earned income shall be disregarded. (B) No amount that the individual's employer pays to obtain health insurance for one or more members of the individual's family, including any amount of...

...An individual whose income exceeds one hundred fifty per cent of the federal poverty line shall pay an annual premium as a condition of qualifying for the medicaid buy-in for workers with disabilities program. The amount of the premium shall be determined as follows: (A) Subtract one hundred fifty per cent of the federal poverty line, as applicable for a family size equal to the size of the individual's famil...

...No individual shall be denied eligibility for the medicaid buy-in for workers with disabilities program on the basis that the individual receives services under a home and community-based services medicaid waiver component.

...An individual participating in the medicaid buy-in for workers with disabilities program may continue to participate in the program for up to six months even though the individual ceases to have earnings from employment or to be an employed individual with a medically improved disability due to ceasing to be employed if the individual continues to meet all other eligibility requirements for the program.

... requires that a provision of the medicaid buy-in for workers with disabilities program be changed or removed in order for the secretary to approve the program or to avoid an extended delay in the secretary's approval, the medicaid director shall make the change or removal. The change or removal may cause the medicaid buy-in for workers with disabilities program to include a provision that is inconsistent with ...

...(A) The medicaid director shall adopt rules under section 5163.02 of the Revised Code as necessary to implement the medicaid buy-in for workers with disabilities program. The rules shall do all of the following: (1) Specify assets, asset values, and amounts to be disregarded in determining asset and income eligibility limits for the program; (2) Establish meanings for the terms "earned income," "health insur...

...lable to pregnant women under the medicaid program during presumptive eligibility periods. ( 2) "Qualified provider" has the same meaning as in section 1920(b)(2) of the "Social Security Act," 42 U.S.C. 1396r-1(b)(2). (B) The medicaid director shall implement the presumptive eligibility for pregnant women option. Any entity that is eligible to be a qualified provider and requests to serve as a qualified provider m...

...s available to children under the medicaid program during presumptive eligibility periods. (5) "Qualified entity" has the same meaning as in section 1920A(b)(3) of the "Social Security Act," 42 U.S.C. 1396r-1a(b)(3). (B) The medicaid director shall implement the presumptive eligibility for children option. Children's hospitals, federally qualified health centers, and federally qualified health center look-alikes, ...

...ich a qualified entity or qualified provider deems an individual presumptively eligible for medicaid under sections 5163.10 to 5163.102 of the Revised Code when the individual is ineligible for the medicaid program. (2) "Qualified entity" has the same meaning as in section 5163.101 of the Revised Code. (3) "Qualified provider" has the same meaning as in section 5163.10 of the Revised Code. (B) Notwithstandin...

...e. Quarterly, the department of medicaid shall report to the general assembly the presumptive eligibility error rate for presumptive eligibility determinations made during the previous quarter. Reports made under this section shall be submitted to the general assembly in accordance with section 101.68 of the Revised Code.

...er federal law, the department of medicaid shall redetermine the eligibility of members of the expansion eligibility group for medicaid benefits every six months.

...If a medicaid recipient is the beneficiary of a trust created pursuant to section 5815.28 of the Revised Code, then, notwithstanding any contrary provision of this chapter or of a rule adopted under section 5163.02 of the Revised Code, divisions (C) and (D) of that section shall apply in determining the assets or resources of the recipient, the recipient's estate, the settlor, or the settlor's estate and to cla...

...ligibility determinations for the medicaid program; (b) An appeal from an initial eligibility determination pursuant to section 5160.31 of the Revised Code. (2)(a) Except as provided in division (A)(2)(b) of this section, this section shall not be used by a court to determine the effect of a trust on an individual's initial eligibility for the medicaid program. (b) The prohibition in division (A)(2)(a) of this sec...

...tate has an insurable interest in medicaid recipients because of the state's statutory right to recover from the estate of a recipient state funds used to provide the recipient with medicaid services. (B) As used in this section: (1) "Beneficiary" means the person or entity designated in a life insurance policy to receive the proceeds of the policy on the death of the insured or maturity of the policy. (2) "...

...n: (1) "Assets" include all of an individual's income and resources and those of the individual's spouse, including any income or resources the individual or spouse is entitled to but does not receive because of action by any of the following: (a) The individual or spouse; (b) A person or government entity, including a court or administrative agency, with legal authority to act in place of or on behalf of the indi...

...(A) Except as provided by division (A) of this section and for the purpose of determining whether an aged, blind, or disabled individual is eligible for nursing facility services, ICF/IID services, or other medicaid-funded long-term care services, the medicaid director may consider an aged, blind, or disabled individual's real property to not be the individual's homestead or principal place of residence once th...