5160:1-1-63.2 Medicaid: continuous eligibility for children younger than age nineteen.

 

 

 

TO BE RESCINDED

 

5160:1-1-63.2              Medicaid: continuous eligibility for children younger than age nineteen.

 

 

 

(A)    This rule describes the twelve-month period of continuous eligibility for a child younger than age nineteen, and the conditions under which the child's coverage ends during the twelve-month period, as described in section 1902(e)(12) of the Social Security Act (as in effect on October 1, 2013).

 

(B)    Eligibility criteria. A child remains eligible for coverage despite changes in the child's circumstances for a period of twelve months if the child was found to be eligible for a category of medical assistance other than:

 

(1)   Presumptive eligibility as described in Chapter 5160:1-1 or Chapter 5160:1-2 of the Administrative Code;

 

(2)     Alien  emergency  medical  assistance  as  described  in  rule  5160:1-5-20  or 5160:1-1-91 of the Administrative Code; or

 

(3)       Refugee   medical   assistance   as   described   in   rule   5160:1-6-90   of   the Administrative Code.

 

(C)  Duration.

 

(1)  A child's twelve-month period of continuous eligibility begins:

 

(a)     On the date that medical assistance began as a result of an initial determination or annual redetermination in accordance with rule 5160:1-2-01.2 or rule 5160:1-1-51 of the Administrative Code,

 

(b)   Without regard to any months of retroactive eligibility.

 

(2)   The child's coverage shall be terminated during the continuous eligibility period only:

 

(a)    Upon oral or written request of the child (if the child is at least eighteen years old) or the child's representative; or

 

(b)   When the child:

 

(i)   No longer resides in the state of Ohio; or

 

 

(ii)   Dies; or

(iii)     Has not paid the premium amounts required for coverage, if the child is covered under the medicaid buy-in for workers with disabilities category described in rule 5160:1-5-30 of the Administrative Code; or

(iv)   Reaches age nineteen.

(D)  Spenddown, patient liability, or premium.

(1)   A spenddown, patient liability, or premium calculated for a child in accordance with Chapters 5160:1-3 to 5160:1-6 of the Administrative Code shall not increase during the child's continuous coverage period. Any decrease in a child's spenddown, patient liability, or premium results in a new maximum amount, which will not increase for the remainder of the child's continuous coverage period.

(2)   If a child is eligible for medical assistance only through the spenddown process set forth in Chapter 5160:1-3 of the Administrative Code, the child will not receive medical assistance in any month until the child's spenddown has been satisfied for that month.

(E)   Regardless of a child's status under this rule, payment for services shall not be made if payment is prohibited under rule 5160:1-1-58.1 of the Administrative Code.

Effective:	08/01/2016
Five Year Review (FYR) Dates:	04/15/2016
CERTIFIED ELECTRONICALLY
Certification
07/12/2016
Date
Promulgated Under:	111.15
Statutory Authority:	5162.031, 5163.02
Rule Amplifies: Prior Effective Dates:	5163.02, 5163.03 4/1/10 (Emer.), 7/1/10, 10/15/10