5160:1-1-04. Medicaid: income and eligibility verification system (IEVS)

(A) This rule describes the requirements in section 1137 of the Social Security Act (as in effect on May 1, 2014) and in section 42 C.F.R. 435.945 (as in effect on May 1, 2014), requiring state agencies administering certain federally funded, state administered public assistance programs, to establish procedures for obtaining, using and verifying information relevant to determinations of eligibility. The Ohio department of medicaid shall obtain and share income and benefit information with the following sources:

(1) The social security administration (SSA).

(2) The internal revenue service (IRS).

(3) The state wage information collection agency (SWICA).

(4) The agencies administering the State unemployment compensation (UC) laws.

(B) Definition. "IEVS" is defined in rule 5160:1-1-50.1 of the Administrative Code.

(C) Administrative agency responsibilities. The administrative agency shall:

(1) Provide adequate safeguards in accordance with rule 5160:1-1-51.1 of the Administrative Code.

(2) Inform all individuals in writing at the time of application and reapplication that the agency will obtain and use information available from IEVS to verify an individual's eligibility for medicaid.

(3) Within forty-five days of receipt of the information, review and compare against the case record all information received to determine whether it affects the individual's eligibility. Obtain verification, if appropriate, to determine eligibility and initiate appropriate action in accordance with 42 C.F.R. 435.952(c) (as in effect on May 1, 2014). For applicants, if the information is received during the application period, it must be used to the extent possible to make eligibility determinations, in accordance with 42 C.F.R. 435.952(b) (as in effect on May 1, 2014).

(4) Verify the information, in accordance with 42 C.F.R. 435.948 (as in effect on May 1, 2014) and 42 C.F.R. 435.949 (as in effect on May 1, 2014).

(5) Not terminate, deny, suspend benefits until appropriate steps have been taken to verify the information in accordance with 42 C.F.R. 435.952(d) (as in effect on May 1, 2014). The administrative agency shall verify information relating to:

(a) The amount of the income and resource involved;

(b) Whether the individual actually has or had access and use of the resource, income, or both;

(c) The period of time during which the individual actually has or had access to the resource, income, or both.

(6) Maintain the individual's data in a standardized format that allows the administrative agency to furnish and to obtain eligibility and income information from the agencies or programs referenced in 42 C.F.R. 435.945 and 42 C.F.R. 435.948(a) in accordance with 42 C.F.R. 435.960(a) (as in effect on May 1, 2014).

Replaces: 5160:1-1- 03.1

Effective: 1/10/2015
Five Year Review (FYR) Dates: 01/10/2020
Promulgated Under: 111.15
Statutory Authority: 5160.02, 5163.02
Rule Amplifies: 5160.02, 5163.02
Prior Effective Dates: 1/1/83, 12/1/86, 3/13/87 (Emer.), 5/4/87, 9/1/89 (Emer.), 11/30/89, 1/1/90 (Emer.), 4/1/90, 1/1/93, 9/1/94, 11/1/96, 7/1/98, 7/1/99, 10/1/02, 10/06/03, 11/1/09