5160:1-2-14 Medicaid: continuous eligibility for children younger than age nineteen.  

  • Text Box: ACTION: Final Text Box: DATE: 07/12/2016 1:18 PM

     

     

     

    5160:1-2-14                 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 January 1, 2016 ).

     

    (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  5160:1-1-05  or 5160:1-5-06 of the Administrative Code; or

     

    (3)Refugee   medical   assistance   as   described   in   rule   5160:1-5-05   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 renewal in accordance with rule 5160:1-2-01 or rule 5160:1-2-01.2 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 5160:1-5-03 of the Administrative Code; or

     

     

     

     

    (iv) Reaches age nineteen.

    (D) Patient liability, or premium. A 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 patient liability or premium results in a new maximum amount, which will not increase for the remainder of the child's continuous coverage period.

    (E) Regardless of a child's status under this rule, payment for services shall not be made if payment is prohibited under rule 5160:1-1-05 of the Administrative Code.

    Replaces:                                                              5160:1-1-63.2

    Effective:                                                             08/01/2016

    Five Year Review (FYR) Dates:                         08/01/2021

    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, 12/20/13, 1/1/14

Document Information

Effective Date:
8/1/2016
File Date:
2016-07-12
Last Day in Effect:
2016-08-01
Rule File:
5160$1-2-14_FF_N_RU_20160712_1318.pdf
Related Chapter/Rule NO.: (1)
Ill. Adm. Code 5160:1-2-14. [Effective 8/1/2016] Medicaid: continuous eligibility for children younger than age nineteen