5101:1-5-01 The disability financial assistance program: definitions and payment standards.

 

 

 

TO BE RESCINDED

 

5101:1-5-01                 The  disability  assistance  program  definitions  and  payment standards.

 

 

 

(A)  Definition of the disability assistance program

 

(1)   Disability assistance (DA) is a state and county funded program which provides cash and/or medical assistance to persons ineligible for public assistance programs that are supported in whole or in part by federal funds (e.g., Ohio works first (OWF), supplemental security income (SSI)). No federal regulations govern the administration of the DA program. The DA program provides assistance to eligible individuals to maintain health and meet basic needs.

 

(2)     When an assistance group is ineligible for any public assistance program supported in whole or in part by federal funds, the CDJFS shall explore DA eligibility. DA shall be authorized on an ongoing basis as long as all eligibility factors are met. It is not appropriate to issue DA as temporary assistance to applicants or recipients of Ohio works first. DA may be issued as temporary assistance to an assistance group pending federal categorical eligibility for SSI, if the individual is a member of one of the categories of covered individuals set forth in paragraphs (D)(1)(a) to (D)(1)(e) of this rule. If the assistance group is subsequently determined ineligible for SSI, DA benefits may continue if all other eligibility factors are met.

 

(3)    The DA program has two separate components: DA cash assistance and DA medical assistance. The individuals who are potentially eligible for these components are delineated in paragraphs (C)(1)(a) to (C)(1)(b) of this rule.

 

(B)  Definition and formation of the DA family group

 

(1)   The "family group" is defined as the assistance group (as set forth in paragraph

(C)   of this rule), and any persons related to any member of the assistance group by blood, adoption (i.e., parents and their children), or marriage who are living in the same home as the assistance group.

 

(a)       The family group shall include all children, their siblings and half-siblings, under the age of eighteen who are living with their biological or adoptive parents. Additionally, a married individual who is living with his spouse must be included in the same family group with his spouse (the definition of marriage is set forth in rule 5101:1-3-03 of the Administrative Code). If the spouse has biological or adoptive children under age eighteen living with him, those children

 

 

 

must also be included in the family group.

(b)   A dependent child who is receiving DA as a result of living with someone who is standing in place of a parent, who is eligible for DA in his own right, shall not be included in that individual's family group.

(c)   An individual who is living in a residential treatment center for substance abuse that is certified by the Ohio department of alcohol and drug addiction services (as set forth in paragraph (D)(4) of this rule) shall constitute his own family group, and shall not be included in another family group while he remains in the residential treatment facility.

(d)   The income and resources of all members of the family group are used in determining the eligibility of the assistance group for DA financial assistance and DA medical assistance, as set forth in rules 5101:1-5-30 and 5101:1-5-40 of the Administrative Code.

(e)      The income, resources, and needs of the following individuals are excluded from the family group:

(i)   OWF participants.

(ii)   SSI recipients.

(iii)   Individuals for whom federal, state or local foster care maintenance payments are made.

(iv)     Individuals for whom federal, state or local adoption assistance payments are made.

(2)   The family group is formed by selecting the following individuals:

(a)       Siblings and half-siblings under the age of eighteen (including emancipated minors and pregnant minors);

(b)   The parent(s) of the children included in the family group;

(c)   The spouse(s) of all members of the family group; and,

(d)  Any children of the spouse.

(C)  Definition and formation of the DA assistance group.

(1)    The "assistance group" is defined as a group of applicants for or recipients of DA who are living together and treated as a unit for purposes of determining eligibility for DA and establishing the amount of DA benefits for which the group is eligible. The assistance group is formed by selecting all of the covered individuals (as set forth in paragraph (D) of this rule) from the family group (as defined in paragraph (B) of this rule). The assistance group can be the same composition as the family group, or a smaller group within the family group, depending upon the number of covered individuals within the family group. There are two types of assistance groups in the DA program which are defined as follows:

(a)    The DA cash assistance group is defined as a group of applicants for or recipients of DA cash assistance who are living together and treated as a unit for purposes of determining eligibility for and the amount of DA cash assistance benefits for which the group is eligible. The DA cash assistance group is the assistance group that is formed first, after the formation of the family group and is formed by selecting all of the covered individuals (as set forth in paragraph (D) of this rule) from the family group. The DA cash assistance group can be different from the family group and the DA medical assistance group, depending upon the number of DA cash covered individuals within the family group.

(b)   The DA medical assistance group is defined as a group of applicants for or recipients of DA medical benefits who are living together and treated as a unit for purposes of determining eligibility for DA medical assistance. The DA medical assistance group is the assistance group that is formed after the formation of the DA cash assistance group and is formed by selecting all of the covered individuals (as set forth in paragraph (D)(5) of this rule) from the family group. The DA medical assistance group can be different than the DA cash assistance group, depending upon the number of DA medical covered individuals within the family group. All DA cash recipients who are not eligible for medicaid under a medicaid-covered group (as set forth in Chapters 5101:1-39 and 5101:1-40 of the Administrative Code) are members of the DA medical assistance group.

(2)    The assistance group is formed by selecting the following covered individuals (defined in paragraph (D) of this rule) from the family group.

(a)   When there are children, the assistance group shall contain the following covered individuals:

(i)     Siblings  and  half-siblings  under  the  age  of  eighteen  (including emancipated minors and pregnant minors).

(ii)   The parents of the children.

(iii)   The spouse(s) of all members of the assistance group.

(iv)   The spouse's children.

(b)     When there are no children, the assistance group shall contain the following covered individuals:

(i)   An individual; or

(ii)   A married couple

(D)  Covered individuals

(1)   Eligibility for DA cash assistance is limited to the following individuals:

(a)     Children under the age of eighteen (includes emancipated minors as defined in rule 5101:1-5-10 of the Administrative Code); or

(b)   Individuals age sixty or over; or

(c)   Pregnant women (regardless of age); or

(d)  Certain individuals residing in a treatment center certified as an alcohol or drug addiction program by the Ohio department of alcohol and drug addiction services (ODADAS) as set forth in paragraph (D)(4) of this rule; or

(e)      Individuals who are disabled as determined by the county medical services section (CMS). The disability determination process is provided in rule 5101:1-5-20 of the Administrative Code.

(2)   All individuals who are determined potentially eligible for DA, and who do not meet the DA requirements referenced in paragraphs (D)(1)(a) to (D)(1)(d) of this rule, shall have their disability determined through the county medical

services Section (CMS) of the ODJFS.

(3)     DA is the category of financial assistance for a minor child living with a nonrelated caretaker who is standing in place of the parent but does not meet the OWF living arrangement requirement set forth in rule 5101:1-3-03 of the Administrative Code. The individual standing in place of the parent must either be at least eighteen years old or emancipated. A referral to the children services agency may be appropriate in these nonrelative situations.

(4)     A resident of a residential treatment center certified as an alcohol or drug addiction program by the Ohio department of alcohol and drug addiction services (ODADAS), under section 3793.06 of the Revised Code, is potentially eligible for DA cash and medical assistance.

(5)   Eligibility for DA medical assistance is limited to the following individuals:

(a)     Individuals who are eligible for DA cash assistance as set forth in paragraphs (D)(1)(a) to (D)(1)(e) of this rule; or

(b)    Individuals who have been determined to be medication dependent by a licensed physician in accordance with the provisions set forth in rule 5101:1-5-20 of the Administrative Code. If an individual meets all DA eligibility requirements, is pending DA cash assistance only because the disability determination process has not been completed, and is medication dependent, the individual is eligible for DA medical assistance, until the disability determination process is completed and a decision is made by the county medical services section (CMS).

(E)  Ineligible individuals

(1)    The following individuals may meet the eligibility requirements to qualify for DA cash and/or medical assistance, but are ineligible to receive benefits.

(a)    A member of a DA applicant assistance group who has quit or refused employment or training within the past thirty days without good cause shall be determined ineligible for cash and/or medical benefits until that thirty-day period has expired.

(b)     An applicant must not be underemployed or unemployed for reasons within his control. Unemployment as a result of a labor dispute is not within the DA applicant's control. In the event of a firing, the CDJFS shall determine if the dismissal was within the individual's control. An

unemployment compensation decision, if available, shall be used. To determine if the actions which caused the discharge were within the applicant's control, the CDJFS must establish that the applicant has wrongfully committed an act or engaged in a course of conduct in connection with the work which:

(i)      Disregarded or ignored established rules or any standards of behavior which the employer had a right to expect; or

(ii)    Showed carelessness or negligence in the performance of the work to such a degree or recurrence as to have demonstrated a disregard of the employer's interest.

(c)    An assistance group member who fails to cooperate in the securing of medical support shall be ineligible for DA medical assistance.

(d)   An undocumented alien who fails to meet citizenship requirements shall be ineligible for DA cash and/or medical benefits.

(e)    An individual/family who becomes ineligible for SSI due to failure to comply with SSI program requirements is ineligible for DA cash and/or medical assistance.

(f)    In accordance with section 5115.04 of the Revised Code, an individual who is a fugitive felon or an individual who is violating a condition of probation, a community control sanction, parole, or a post-release control sanction imposed under federal or state law shall be ineligible for DA cash and/or medical assistance.

(g)   An individual or assistance group who is ineligible for OWF as a result of any of the following circumstances is ineligible for DA cash and/or medical assistance:

(i)      A penalty has been imposed for failure to comply with the regulations for OWF. This includes individuals or assistance groups who become ineligible as a result of any of the following:

(a)    Provisions set forth in section 5107.14 of the Revised Code (failure to complete the self-sufficiency contract);

(b)    Provisions set forth in section 5107.16 of the Revised Code (sanctions imposed as a result of failing to comply in full

with requirements set forth in the self-sufficiency contract);

(c)    Provisions set forth in section 5101.83 of the Revised Code (receipt of a fraudulent OWF payment).

(ii)       In accordance with section 5107.18 of the Revised Code, ineligibility exists due to the time limit for OWF cash assistance;

(iii)       Failure to comply with an OWF application or verification procedure; or

(iv)   The individual has been disqualified due to an intentional program violation as set forth in Chapter 5101:6-20 of the Administrative Code;

(2)    For purposes of determining the eligibility for any covered individuals in the home (as set forth in paragraph (D) of this rule), the ineligible individual/family is part of the family group, and the resources and income of the ineligible individual/family are countable to the family group.

(3)    Potential DA eligibility exists for those individuals/assistance groups who are ineligible for OWF because one of the assistance group members is on strike as set forth in section 5107.02 of the Revised Code.

(F)   Need

(1)    Need is defined as the deficit between the requirements of the family group according to applicable DA standard and the income available for immediate use.

(a)    An assistance group with available countable income in excess of the appropriate DA standard is not eligible regardless of whether other eligibility factors are met.

(b)     An assistance group with available countable income less than the appropriate DA standard is eligible for financial assistance in an amount equal to the difference between the appropriate DA payment standard less the countable income or the state payment standard for the DA covered individual(s), whichever is the lesser amount, provided all other eligibility factors are met.

(2)     The assistance group must meet all eligibility criteria set forth in chapter 5101:1-5 of the Administrative Code and must not have its needs met by another source of financial assistance.

(3)    The amount of DA benefits to be issued depends upon the number of DA covered individuals in the assistance group. The standard for the appropriate family/assistance group size is provided in paragraph (F)(5) of this rule.

(4)     The DA payment standard is the figure used in evaluating need and in determining eligibility for the DA program. The payment standard is the figure which is used to calculate the actual DA payment and from which all countable income is deducted.

(5)   The following chart shows the DA payment standard:

Number in family/assistance group	DA payment standard
1	$115
2	159
3	193
4	225
5	251
6	281
7	312
8	361
9	394
10	426
11	458
12	490
13	522
14	554
15	594

for each person above 15 add                                              40

(6)   DA is the appropriate category of assistance for a pregnant woman ineligible for OWF. When a medication dependent woman in receipt of DA medical assistance provides medical verification of pregnancy, the CDJFS shall effect the category change to DA cash assistance.

Effective:                                07/01/2003

CERTIFIED ELECTRONICALLY

Certification

06/27/2003

Date

Promulgated Under:   111.15

Statutory Authority:   5115.011, 5115.02, 5115.03,

5115.05, 5115.01

Rule Amplifies:           5115.01, 5115.011, 5115.02,

5115.03, 5115.05

Prior Effective Dates: 7-1-76, 9-1-76, 1-1-85

(Emer.), 4-1-85, 8-1-85

(Emer.), 10-17-85, 8-1-86

(Emer.), 9-15-86 (Emer.),

11-5-86, 4-1-88 (Emer.),

6-30-88, 10-1-91 (Emer.),

12-20-91, 4-1-92 (Emer.),

6-30-92, 7-1-92, 11-1-92,

7-1-93, 9-1-93, 12-30-93

(Emer.), 3-18-94, 7-1-94,

9-1-94, 8-1-95 (Emer.),

10-30-95, 7-1-96 (Emer.),

9-29-96, 10-1-96 (Emer.),

12-20-96, 9-3-97 (Emer.),

10-1-97, 7-1-98, 10-1-99,

7-1-01