5160:1-3-03.5 Medicaid: application of income standards.

 

 

 

TO BE RESCINDED

 

5160:1-3-03.5              Medicaid: need standards.

 

 

 

(A)   The purpose of this rule is to set forth the need standards used in medicaid eligibility determinations for aged, blind, or disabled individuals.

 

(B)  Definitions.

 

(1)    "Need standard" means the income limit above which an individual is either ineligible for a given category of medicaid for the aged, blind or disabled, or is subject to a spenddown in accordance with rules 5160:1-3-03.4 and 5160:1-3-03.9 of the Administrative Code.

 

(2)    "Couple need standard" is equal to the current supplemental security income (SSI) benefit rate for a couple. The updated figure is published annually by the social security administration.

 

(3)    "Individual need standard" is a dollar amount, adjusted annually by the same percentage as the social security cost of living allowance (COLA). The updated figure is published annually in the medicaid eligibility manual via a medicaid eligibility procedure letter (MEPL).

 

(4)    The "special income level" for institutionalized individuals is equal to three hundred per cent of the current supplemental security income (SSI) benefit payment rate for an individual.

 

(5)   The need standards for the medicare premium assistance programs (MPAP) are as follows:

 

(a)    The QMB need standard is one hundred per cent of the federal poverty level.

 

(b)    The SLMB need standard is one hundred twenty per cent of the federal poverty level.

 

(c)    The QI need standard is one hundred thirty-five per cent of the federal poverty level.

 

(d)   The QDWI need standard is two hundred per cent of the federal poverty level.

 

 

 

 

(C)  Application of need standards.

(1)    For an individual, countable income is compared to the appropriate individual need standard. An institutionalized individual, even if married, is treated as an individual.

(2)   For a married couple:

(a)      If both members of the married couple are categorically eligible, countable income is compared to the appropriate couple need standard.

(b)     If only one member of the married couple is categorically eligible, countable income may be compared to either the individual need standard or the couple need standard, in accordance with the deeming provisions set forth in rule 5160:1-3-03.9 of the Administrative Code.

Replaces:                                                              5160:1-3-03.5

Effective:                                                             07/01/2016

Five Year Review (FYR) Dates:                         04/15/2016

CERTIFIED ELECTRONICALLY

Certification

06/20/2016

Date

Promulgated Under:                           111.15

Statutory Authority:                           5160.02, 5163.02

Rule Amplifies:                                  5160.02, 5163.02

Prior Effective Dates:                         9/3/77, 12/31/77, 3/1/79, 10/1/79, 12/7/79, 1/3/80,

7/1/80, 8/1/81, 7/1/82, 12/1/82, 7/1/83 (Temp.),

9/24/83, 1/1/85 (Emer.), 4/1/85, 5/1/85 (Emer.),

7/31/85, 1/1/86 (Emer.), 4/1/86, 1/1/87 (Emer.),

3/20/87, 1/1/88 (Emer.), 2/1/88 (Emer.), 3/21/88,

1/1/89 (Emer.), 4/1/89, 5/1/89 (Emer.), 7/8/89, 1/1/90 (Emer.), 4/1/90, 4/2/90 (Emer.), 6/22/90, 1/1/91 (Emer.), 4/1/91, 4/2/91 (Emer.), 6/17/91, 1/1/92 (Emer.), 3/20/92, 4/1/92 (Emer.), 6/30/92, 1/1/93 (Emer.), 3/18/93, 3/25/93, 6/11/93, 9/1/93, 3/18/94,

2/1/95, 4/01/95 (Emer.), 6/11/95, 4/1/96, 1/1/97 (Emer.), 2/9/97, 12/3/97 (Emer.), 2/1/98, 1/8/99 (Emer.), 4/1/99, 1/1/00, 6/2/01, 5/12/02, 1/25/15