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2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.56 | Health Care Special Activities Fund.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
There is created in the state treasury the health care special activities fund. The department of medicaid shall deposit all funds it receives pursuant to the administration of the medicaid program into the fund, other than any such funds that are required by law to be deposited into another fund. The department shall use the money in the fund to pay for expenses related to the services provided under, and the administration of, the medicaid program.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.65 | Refunds and Reconciliation Fund.

Effective:
September 29, 2017
Latest Legislation:
House Bill 49 - 132nd General Assembly
There is hereby created in the state treasury the refunds and reconciliation fund.
Money the department of medicaid receives from a refund or reconciliation shall be deposited into the refunds and reconciliation fund if the department does not know the appropriate fund for the money at the time the department receives the money or if the money is to go to another government entity. Money transferred from the department of job and family services under section 5101.074 of the Revised Code also shall be deposited into the refunds and reconciliation fund.
Money in the refunds and reconciliation fund, including money transferred from the department of job and family services, shall be transferred to the appropriate fund once the appropriate fund is identified or shall be transferred to another government entity, as appropriate.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.66 | Residents Protection Fund.

Effective:
September 29, 2017
Latest Legislation:
House Bill 49 - 132nd General Assembly
(A) There is hereby created in the state treasury the residents protection fund. All of the following shall be deposited into the fund:
(1) The proceeds of all fines, including interest, collected under sections 5165.60 to 5165.89 of the Revised Code;
(2) The proceeds of all fines, including interest, collected under section 173.42 of the Revised Code;
(3) The portions of civil money penalties and corresponding interest that are disbursed on or after July 1, 2017, to the department of medicaid pursuant to 42 C.F.R. 488.845.
(B)(1) Money deposited into the fund pursuant to divisions (A)(1) and (2) of this section shall be used for all of the following:
(a) Protection of the health or property of residents of nursing facilities in which the department of health finds deficiencies, including payment for the costs of relocation of residents to other facilities;
(b) Maintenance of operation of a facility pending correction of deficiencies or closure;
(c) Reimbursement of residents for the loss of money managed by the facility under section 3721.15 of the Revised Code;
(d) Provision of funds for costs incurred by a temporary resident safety assurance manager appointed under section 5165.78 of the Revised Code.
(2) Subject to 42 C.F.R. 488.845(g)(2), money deposited into the fund pursuant to division (A)(3) of this section shall be used to improve the quality of medicaid services provided by medicare-certified home health agencies.
(C) The fund shall be maintained and administered by the department of medicaid under rules developed in consultation with the departments of health and aging and adopted under section 5162.02 of the Revised Code. The rules shall be adopted in accordance with Chapter 119. of the Revised Code.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.71 | Implementation of Systems to Improve Health and Reduce Health Disparities.

Effective:
March 20, 2014
Latest Legislation:
Senate Bill 206 - 130th General Assembly
The medicaid director shall implement within the medicaid program systems that do both of the following:
(A) Improve the health of medicaid recipients through the use of population health measures;
(B) Reduce health disparities, including, but not limited to, those within racial and ethnic populations.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.72 | Strategies to Address Social Determinants of Health.

Effective:
October 17, 2019
Latest Legislation:
House Bill 166 - 133rd General Assembly
The medicaid director shall implement within the medicaid program strategies that address social determinants of health, including employment, housing, transportation, food, interpersonal safety, and toxic stress.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.73 | Dental Services for Pregnant Medicaid Recipients.

Effective:
September 18, 2020
Latest Legislation:
House Bill 11 - 133rd General Assembly
(A) The Department of Medicaid may establish and administer a program to provide dental services to pregnant Medicaid recipients. If the program is established, all of the following shall apply:
(1) Medicaid recipients who are members of the group described in section 5163.06 of the Revised Code shall be eligible to receive two dental cleanings per year.
(2) The Department shall give priority to those Medicaid recipients residing in areas of the state with high preterm birth rates.
(3) The Department shall inform Medicaid recipients about the program and market the program to Medicaid recipients.
(B) The Department of Medicaid shall establish reimbursement rates for entities that educate Medicaid recipients about the importance of prenatal and postnatal dental care as part of the program described in section 3701.615 of the Revised Code, including reimbursement rates for all or part of the costs associated with developing and distributing educational materials related to the importance of prenatal and postnatal dental care.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.75 | Notification of Veteran Services.

Effective:
September 13, 2022
Latest Legislation:
Senate Bill 160 - 134th General Assembly
The medicaid director shall provide, to a veteran who has submitted an application for the medicaid program, information about the county veterans service office that can assist with investigating and applying for benefits through the United States department of veterans affairs. As used in this section, "veteran" has the same meaning as in section 5901.01 of the Revised Code.
Last updated October 20, 2022 at 4:52 PM
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.80 | Good Faith Estimates for Charges and Payments.

Effective:
January 1, 2017
Latest Legislation:
House Bill 52 - 131st General Assembly
(A) A provider of medical services licensed, accredited, or certified under Chapter 3721., 3727., 4715., 4725., 4731., 4732., 4734., 4747., 4753., 4755., 4757., or 4779. of the Revised Code shall provide in writing, before products, services, or procedures are provided, a reasonable, good-faith estimate of all of the following for the provider's non-emergency products, services, or procedures:
(1) The amount the provider will charge the patient or the consumer's health plan issuer for the product, service, or procedure;
(2) The amount the health plan issuer intends to pay for the product, service, or procedure;
(3) The difference, if any, that the consumer or other party responsible for the consumer's care would be required to pay to the provider for the product, service, or procedure.
(B) Any health plan issuer contacted by a provider described in division (A) of this section in order for the provider to obtain information so that the provider can comply with division (A) of this section shall provide such information to the provider within a reasonable time of the provider's request.
(C) As used in this section, "health plan issuer" means an entity subject to the insurance laws and rules of this state, or subject to the jurisdiction of the superintendent of insurance, that contracts, or offers to contract, to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services under a health benefit plan, including a sickness and accident insurance company and a health insuring corporation. "Health plan issuer" also includes a managed care organization under contract with the department of medicaid and, if the services are to be provided on a fee-for-service basis, the Medicaid program.
(D) The medicaid director shall adopt rules, in accordance with Chapter 119. of the Revised Code, to carry out this section.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.82 | Payment Rate Increase Report to Jmoc.

Effective:
September 30, 2021
Latest Legislation:
House Bill 110 - 134th General Assembly
Before making any payment rate increases greater than ten per cent under the medicaid program, the medicaid director shall notify the joint medicaid oversight committee of the increase and be available to testify before the joint medicaid oversight committee regarding the increase.
Last updated September 9, 2021 at 3:02 PM
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5163 | Medicaid Eligibility › Section 5163.01 | Definitions.

Effective:
September 29, 2017
Latest Legislation:
House Bill 49 - 132nd General Assembly
As used in this chapter:
"Caretaker relative" has the same meaning as in 42 C.F.R. 435.4 as that regulation is amended effective January 1, 2014.
"Expansion eligibility group" means the medicaid eligibility group described in section 1902(a)(10)(A)(i)(VIII) of the "Social Security Act," 42 U.S.C. 1396a(a)(10)(A)(i)(VIII).
"Federal financial participation" has the same meaning as in section 5160.01 of the Revised Code.
"Federal poverty line" has the same meaning as in section 5162.01 of the Revised Code.
"Healthy start component" has the same meaning as in section 5162.01 of the Revised Code.
"Home and community-based services medicaid waiver component" has the same meaning as in section 5166.01 of the Revised Code.
"Intermediate care facility for individuals with intellectual disabilities" and "ICF/IID" have the same meanings as in section 5124.01 of the Revised Code.
"Mandatory eligibility groups" means the groups of individuals that must be covered by the medicaid state plan as a condition of the state receiving federal financial participation for the medicaid program.
"Medicaid buy-in for workers with disabilities program" means the component of the medicaid program established under sections 5163.09 to 5163.098 of the Revised Code.
"Medicaid services" has the same meaning as in section 5164.01 of the Revised Code.
"Medicaid waiver component" has the same meaning as in section 5166.01 of the Revised Code.
"Nursing facility" and "nursing facility services" have the same meanings as in section 5165.01 of the Revised Code.
"Optional eligibility groups" means the groups of individuals who may be covered by the medicaid state plan or a federal medicaid waiver and for whom the medicaid program receives federal financial participation.
"Other medicaid-funded long-term care services" has the meaning specified in rules adopted under section 5163.02 of the Revised Code.
"Supplemental security income program" means the program established by Title XVI of the "Social Security Act," 42 U.S.C. 1381 et seq.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5163 | Medicaid Eligibility › Section 5163.02 | Rules Establishing Eligibility Requirements for Medicaid.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
The medicaid director shall adopt rules as necessary to implement this chapter. The rules shall establish eligibility requirements for the medicaid program. The rules may establish requirements for applying for medicaid and determining and verifying eligibility for medicaid. The rules shall be adopted in accordance with section 111.15 of the Revised Code.
( Notwithstanding any provision of state law, including statutes, administrative rules, common law, and court rules, regarding real or personal property or domestic relations, the standards established under rules adopted under this section shall be used to determine eligibility for medicaid.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5163 | Medicaid Eligibility › Section 5163.03 | Medicaid Coverage.

Effective:
November 22, 2017
Latest Legislation:
House Bill 49 - 132nd General Assembly
(A) Subject to section 5163.05 of the Revised Code, the medicaid program shall cover all mandatory eligibility groups.
(B) The medicaid program shall cover all of the optional eligibility groups that state statutes require the medicaid program to cover.
(C) The medicaid program may cover any of the optional eligibility groups to which either of the following applies:
(1) State statutes expressly permit the medicaid program to cover the optional eligibility group.
(2) The medicaid program covers the optional eligibility group on the effective date of this amendment.
(D) The medicaid program shall not cover an optional eligibility group to which either of the following applies:
(1) State statutes prohibit the medicaid program from covering the optional eligibility group.
(2) Except as provided in divisions (B) and (C)(1) of this section, the medicaid program does not cover the optional eligibility group on the effective date of this amendment.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5163 | Medicaid Eligibility › Section 5163.05 | Eligibility Requirements for Aged, Blind, and Disabled.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
The medicaid program's eligibility requirements for aged, blind, and disabled individuals may be more restrictive than the eligibility requirements for the supplemental security income program. Any such more restrictive eligibility requirements shall be consistent with the 209(b) option described in the "Social Security Act," section 1902(f), 42 U.S.C. 1396a(f).
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5163 | Medicaid Eligibility › Section 5163.06 | Optional Eligibility Groups.

Effective:
October 3, 2023
Latest Legislation:
House Bill 33 - 135th General Assembly
The medicaid program shall cover all of the following optional eligibility groups:
(A) The group consisting of children placed with adoptive parents who are specified in section 1902(a)(10)(A)(ii)(VIII) of the "Social Security Act," 42 U.S.C. 1396a(a)(10)(A)(ii)(VIII);
(B) Subject to section 5163.061 of the Revised Code, the group consisting of women during pregnancy and the maximum postpartum period permitted under 42 U.S.C. 1396a(e) beginning on the last day of the pregnancy, infants, and children who are specified in section 1902(a)(10)(A)(ii)(IX) of the "Social Security Act," 42 U.S.C. 1396a(a)(10)(A)(ii)(IX);
(C) The group consisting of employed individuals with disabilities who are specified in section 1902(a)(10)(A)(ii) (XIII) of the "Social Security Act," 42 U.S.C. 1396a(a)(10)(A) (ii)(XIII);
(D) Subject to sections 5163.09 to 5163.098 of the Revised Code, the group consisting of employed individuals with disabilities who are specified in section 1902(a)(10)(A)(ii)(XV) of the "Social Security Act," 42 U.S.C. 1396a(a)(10)(A)(ii)(XV);
(E) Subject to sections 5163.09 to 5163.098 of the Revised Code, the group consisting of employed individuals with medically improved disabilities who are specified in section 1902(a)(10)(A)(ii)(XVI) of the "Social Security Act," 42 U.S.C. 1396a(a)(10)(A)(ii)(XVI);
(F) The group consisting of independent foster care adolescents who are specified in section 1902(a)(10)(A)(ii)(XVII) of the "Social Security Act," 42 U.S.C. 1396a(a)(10)(A)(ii)(XVII);
(G) The group consisting of women in need of treatment for breast or cervical cancer who are specified in section 1902(a)(10)(A)(ii)(XVIII) of the "Social Security Act," 42 U.S.C. 1396a(a)(10)(A)(ii)(XVIII).
Last updated October 6, 2023 at 12:26 PM
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5163 | Medicaid Eligibility › Section 5163.061 | Income Eligibility Threshold for Pregnant Women.

Effective:
September 30, 2021
Latest Legislation:
House Bill 110 - 134th General Assembly
The income eligibility threshold is two hundred per cent of the federal poverty line for women during pregnancy and the postpartum period beginning on the last day of the pregnancy who are covered by the medicaid program under division (B) of section 5163.06 of the Revised Code.
Last updated August 16, 2021 at 3:36 PM
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5163 | Medicaid Eligibility › Section 5163.063 | Medicaid Coverage of Employed Individuals With a Disability.

Effective:
October 3, 2024
Latest Legislation:
House Bill 33 - 135th General Assembly
The medicaid director shall adopt rules under section 5163.02 of the Revised Code as necessary to provide medicaid coverage for the optional eligibility group described in section 1902(a)(10)(A)(ii)(XIII) of the "Social Security Act," 42 U.S.C. 1396a(a)(10)(A)(ii)(XIII).
By requiring the medicaid program to provide coverage to the optional eligibility group consisting of employed individuals with disabilities under division (C) of section 5163.06 of the Revised Code, it is the intent of the general assembly to establish medicaid coverage for employed individuals with disabilities who are sixty-five years of age or older in a manner that is consistent with the coverage provided to individuals participating in the medicaid buy-in for workers with disabilities program described in sections 5163.09 to 5163.098 of the Revised Code.
Last updated October 6, 2023 at 5:06 PM
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5163 | Medicaid Eligibility › Section 5163.07 | Income Eligibility Threshold for Parents and Caretaker Relatives.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
The medicaid director shall implement the option authorized by the "Social Security Act," section 1931(b)(2)(C), 42 U.S.C. 1396u-1(b)(2)(C), to set the income eligibility threshold at ninety per cent of the federal poverty line for parents and caretaker relatives who are covered by the medicaid program under that section of the "Social Security Act."
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5163 | Medicaid Eligibility › Section 5163.09 | Medicaid Buy-in for Workers With Disabilities Program.

Effective:
March 20, 2014
Latest Legislation:
Senate Bill 206 - 130th General Assembly
(A) As used in sections 5163.09 to 5163.098 of the Revised Code:
"Applicant" means an individual who applies to participate in the medicaid buy-in for workers with disabilities program.
"Earned income" has the meaning established by rules authorized by section 5163.098 of the Revised Code.
"Employed individual with a medically improved disability" has the same meaning as in the "Social Security Act," section 1905(v), 42 U.S.C. 1396d(v).
"Family" means an applicant or participant and the spouse and dependent children of the applicant or participant. If an applicant or participant is under eighteen years of age, "family" also means the parents of the applicant or participant.
"Health insurance" has the meaning established by rules authorized by section 5163.098 of the Revised Code.
"Income" means earned income and unearned income.
"Participant" means an individual who has been determined eligible for the medicaid buy-in for workers with disabilities program and is participating in the program.
"Resources" has the meaning established by rules authorized by section 5163.098 of the Revised Code.
"Spouse" has the meaning established by rules authorized by section 5163.098 of the Revised Code.
"Unearned income" has the meaning established by rules authorized by section 5163.098 of the Revised Code.
(B) The medicaid program's coverage of the optional eligibility groups specified in the "Social Security Act," section 1902(a)(10)(A)(ii)(XV) and (XVI), 42 U.S.C. 1396a(a)(10)(A)(ii)(XV) and (XVI) shall be known as the medicaid buy-in for workers with disabilities program.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5163 | Medicaid Eligibility › Section 5163.091 | Qualifications for Program.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
Under the medicaid buy-in for workers with disabilities program, an individual who does all of the following in accordance with rules authorized by section 5163.098 of the Revised Code qualifies for the medicaid program:
(A) Applies for the medicaid buy-in for workers with disabilities program;
(B) Provides satisfactory evidence of all of the following:
(1) That the individual is at least sixteen years of age and under sixty-five years of age;
(2) Except as provided in section 5163.096 of the Revised Code, that one of the following applies to the individual:
(a) The individual is considered disabled for the purpose of the supplemental security income program, regardless of whether the individual receives supplemental security income benefits, and the individual has earnings from employment.
(b) The individual is an employed individual with a medically improved disability.
(3) That the value of the individual's resources, less amounts disregarded pursuant to rules authorized by section 5163.098 of the Revised Code, does not exceed the amount provided for by section 5163.092 of the Revised Code;
(4) That the individual's income, less amounts disregarded pursuant to section 5163.093 of the Revised Code, does not exceed two hundred fifty per cent of the federal poverty line;
(5) That the individual meets the additional eligibility requirements for the medicaid buy-in for workers with disabilities program established in rules authorized by section 5163.098 of the Revised Code.
(C) To the extent required by section 5163.094 of the Revised Code, pays the premium established under that section.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5163 | Medicaid Eligibility › Section 5163.092 | Resource Eligibility Limit - Annual Adjustment.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
(A) Except as provided in division (B) of this section, the maximum value of resources, less amounts disregarded pursuant to rules authorized by section 5163.098 of the Revised Code, that an individual may have without the individual exceeding the resource eligibility limit for the medicaid buy-in for workers with disabilities program shall not exceed ten thousand dollars.
(B) Each calendar year, the medicaid director shall adjust the resource eligibility limit specified in division (A) of this section by the change in the consumer price index for all items for all urban consumers for the previous calendar year, as published by the United States bureau of labor statistics. The annual adjustment shall go into effect on the earliest date possible.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5163 | Medicaid Eligibility › Section 5163.093 | Individual Income Eligibility Limit.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
For the purpose of determining whether an individual is within the income eligibility limit for the medicaid buy-in for workers with disabilities program, all of the following apply:
(A) Twenty thousand dollars of the individual's earned income shall be disregarded.
(B) No amount that the individual's employer pays to obtain health insurance for one or more members of the individual's family, including any amount of a premium established under section 5163.094 of the Revised Code that the employer pays, shall be treated as the individual's income.
(C) Any other amounts, if any, specified in rules authorized by section 5163.098 of the Revised Code shall be disregarded from the individual's earned income, unearned income, or both.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5163 | Medicaid Eligibility › Section 5163.094 | Amount of Annual Individual Premium.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
An individual whose income exceeds one hundred fifty per cent of the federal poverty line shall pay an annual premium as a condition of qualifying for the medicaid buy-in for workers with disabilities program. The amount of the premium shall be determined as follows:
(A) Subtract one hundred fifty per cent of the federal poverty line, as applicable for a family size equal to the size of the individual's family, from the amount of the income of the individual's family;
(B) Subtract an amount specified in rules authorized by section 5163.098 of the Revised Code from the difference determined under division (A) of this section;
(C) Multiply the difference determined under division (B) of this section by one tenth.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5163 | Medicaid Eligibility › Section 5163.095 | Eligibility Not Denied Due to Services Received Under Home and Community-Based Services Medicaid Waiver Component.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
No individual shall be denied eligibility for the medicaid buy-in for workers with disabilities program on the basis that the individual receives services under a home and community-based services medicaid waiver component.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5163 | Medicaid Eligibility › Section 5163.096 | Continued Participation Where Employment Ceases.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
An individual participating in the medicaid buy-in for workers with disabilities program may continue to participate in the program for up to six months even though the individual ceases to have earnings from employment or to be an employed individual with a medically improved disability due to ceasing to be employed if the individual continues to meet all other eligibility requirements for the program.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5163 | Medicaid Eligibility › Section 5163.097 | Director to Make Federally Required Changes.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
If the United States secretary of health and human services requires that a provision of the medicaid buy-in for workers with disabilities program be changed or removed in order for the secretary to approve the program or to avoid an extended delay in the secretary's approval, the medicaid director shall make the change or removal. The change or removal may cause the medicaid buy-in for workers with disabilities program to include a provision that is inconsistent with sections 5163.09 to 5163.096 of the Revised Code. Such a change or removal shall be made only to the extent necessary to obtain the United States secretary's approval or avoid an extended delay in the secretary's approval and shall be reflected in rules authorized by section 5163.098 of the Revised Code.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5163 | Medicaid Eligibility › Section 5163.098 | Program Implementing Rules; Disregarded Income.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
(A) The medicaid director shall adopt rules under section 5163.02 of the Revised Code as necessary to implement the medicaid buy-in for workers with disabilities program. The rules shall do all of the following:
(1) Specify assets, asset values, and amounts to be disregarded in determining asset and income eligibility limits for the program;
(2) Establish meanings for the terms "earned income," "health insurance," "resources," "spouse," and "unearned income";
(3) Establish additional eligibility requirements for the program that must be established for the United States secretary of health and human services to approve the program;
(4) For the purpose of division (B) of section 5163.094 of the Revised Code, specify an amount to be subtracted from the difference determined under division (A) of that section.
(B) The director may adopt rules under section 5163.02 of the Revised Code to specify amounts to be disregarded from an individual's earned income, unearned income, or both under division (C) of section 5163.093 of the Revised Code for the purpose of determining whether the individual is within the income eligibility limit for the medicaid buy-in for workers with disabilities program.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5163 | Medicaid Eligibility › Section 5163.10 | Implementation of the Presumptive Eligibility for Pregnant Women Option.

Effective:
April 6, 2017
Latest Legislation:
Senate Bill 332 - 131st General Assembly
(A) As used in this section:
( 1) "Presumptive eligibility for pregnant women option" means the option available under section 1920 of the "Social Security Act," 42 U.S.C. 1396r-1, to make ambulatory prenatal care available to pregnant women under the medicaid program during presumptive eligibility periods.
( 2) "Qualified provider" has the same meaning as in section 1920(b)(2) of the "Social Security Act," 42 U.S.C. 1396r-1(b)(2).
(B) The medicaid director shall implement the presumptive eligibility for pregnant women option. Any entity that is eligible to be a qualified provider and requests to serve as a qualified provider may serve as a qualified provider for purposes of the presumptive eligibility for pregnant women option if the department of medicaid determines the entity is capable of making determinations of presumptive eligibility for pregnant women.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5163 | Medicaid Eligibility › Section 5163.101 | Implementation of the Presumptive Eligibility for Children Option.

Effective:
April 6, 2017
Latest Legislation:
Senate Bill 332 - 131st General Assembly
(A) As used in this section:
(1) "Children's hospital" has the same meaning as in section 2151.86 of the Revised Code.
(2) "Federally qualified health center" has the same meaning as in section 1905(l)(2)(B) of the "Social Security Act," 42 U.S.C. 1396d(l)(2)(B).
(3) "Federally qualified health center look-alike" has the same meaning as in section 3701.047 of the Revised Code.
(4) "Presumptive eligibility for children option" means the option available under section 1920A of the "Social Security Act," 42 U.S.C. 1396r-1a, to make medical assistance with respect to health care items and services available to children under the medicaid program during presumptive eligibility periods.
(5) "Qualified entity" has the same meaning as in section 1920A(b)(3) of the "Social Security Act," 42 U.S.C. 1396r-1a(b)(3).
(B) The medicaid director shall implement the presumptive eligibility for children option. Children's hospitals, federally qualified health centers, and federally qualified health center look-alikes, if they are eligible to be qualified entities and request to serve as qualified entities, may serve as qualified entities for purposes of the presumptive eligibility for children option. The director may authorize other types of entities that are eligible to be qualified entities and request to serve as qualified entities to serve as qualified entities for purposes of the presumptive eligibility for children option.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5163 | Medicaid Eligibility › Section 5163.103 | Presumptive Eligibility Error Rate Training.

Effective:
October 3, 2023
Latest Legislation:
House Bill 33 - 135th General Assembly
(A) As used in this section:
(1) "Presumptive eligibility error rate" means the rate at which a qualified entity or qualified provider deems an individual presumptively eligible for medicaid under sections 5163.10 to 5163.102 of the Revised Code when the individual is ineligible for the medicaid program.
(2) "Qualified entity" has the same meaning as in section 5163.101 of the Revised Code.
(3) "Qualified provider" has the same meaning as in section 5163.10 of the Revised Code.
(B) Notwithstanding sections 5163.10 to 5163.102 of the Revised Code, the department of medicaid shall require each qualified entity or qualified provider that has a presumptive eligibility error rate exceeding seven and one-half per cent in a calendar month to do both of the following:
(1) Submit to the department for approval a corrective action plan specifying the steps the qualified entity or qualified provider will take to reduce its presumptive eligibility error rate, including details about the training required under division (B)(2) of this section;
(2) Provide training for all of its staff who make presumptive eligibility determinations to ensure their thorough knowledge of presumptive eligibility prescreening procedures. The training shall occur for each month the qualified entity or qualified provider's presumptive eligibility error rate exceeds seven and one-half per cent.
Last updated October 12, 2023 at 11:40 AM
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5163 | Medicaid Eligibility › Section 5163.20 | Beneficiary of Disability Trust.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
If a medicaid recipient is the beneficiary of a trust created pursuant to section 5815.28 of the Revised Code, then, notwithstanding any contrary provision of this chapter or of a rule adopted under section 5163.02 of the Revised Code, divisions (C) and (D) of that section shall apply in determining the assets or resources of the recipient, the recipient's estate, the settlor, or the settlor's estate and to claims arising under this chapter against the recipient, the recipient's estate, the settlor, or the settlor's estate.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5163 | Medicaid Eligibility › Section 5163.22 | Life Insurance Policies.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
(A) The general assembly hereby finds that the state has an insurable interest in medicaid recipients because of the state's statutory right to recover from the estate of a recipient state funds used to provide the recipient with medicaid services.
(B) As used in this section:
(1) "Beneficiary" means the person or entity designated in a life insurance policy to receive the proceeds of the policy on the death of the insured or maturity of the policy.
(2) "Owner" means the person who has the right to designate the beneficiary of a life insurance policy and to change the designation.
(C) The value of a life insurance policy that would otherwise be considered a resource in determining eligibility for the medicaid program shall be excluded from any determination of a person's eligibility for the medicaid program if the owner designates the department of medicaid as beneficiary of the policy. The department may pay premiums to keep the policy in force. Premiums paid by the department are medicaid payments correctly paid on behalf of a medicaid recipient and subject to recovery under section 5162.21 of the Revised Code.
(D) The medicaid director shall deposit the proceeds of a life insurance policy that do not exceed the amount the department may recover against the property and estate of the owner under section 5162.21 of the Revised Code into the general revenue fund. The director shall pay any remaining proceeds to the person designated by the owner. If the owner failed to designate a person, the director shall pay the remaining proceeds to the surviving spouse, or, if there is no surviving spouse, to the estate of the owner.
(E) If the owner designates the department of medicaid as the policy's beneficiary, the department shall notify the owner that the owner may designate a person to receive proceeds of the policy that exceed the amount the department may recover against the owner's property and estate under section 5162.21 of the Revised Code. The designation shall be made on a form provided by the department.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5163 | Medicaid Eligibility › Section 5163.31 | Real Property Not Homestead After 13-Month Institutional Residence.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
(A) Except as provided by division (A) of this section and for the purpose of determining whether an aged, blind, or disabled individual is eligible for nursing facility services, ICF/IID services, or other medicaid-funded long-term care services, the medicaid director may consider an aged, blind, or disabled individual's real property to not be the individual's homestead or principal place of residence once the individual has resided in a nursing facility, ICF/IID, or other medical institution for at least thirteen months.
(B) Division (A) of this section does not apply to an individual if any of the following reside in the individual's real property that, because of this division, continues to be considered the individual's homestead or principal place of residence:
(1) The individual's spouse;
(2) The individual's child if any of the following apply:
(a) The child is under twenty-one years of age.
(b) The child is considered blind or disabled under the "Social Security Act," section 1614, 42 U.S.C. 1382c.
(c) The child is financially dependent on the individual for housing as determined in accordance with rules adopted under section 5163.02 of the Revised Code.
(3) The individual's sibling if the sibling has a verified equity interest in the real property and resided in the real property for at least one year immediately before the date the individual was admitted to the nursing facility, ICF/IID, or other medical institution.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5163 | Medicaid Eligibility › Section 5163.32 | Equity Interest in Home Exceeds $500,000.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
(A) Except as otherwise provided by this section, no individual shall qualify for nursing facility services or other medicaid-funded long-term care services if the individual's equity interest in the individual's home exceeds five hundred thousand dollars. The medicaid director shall increase this amount effective January 1, 2011, and the first day of each year thereafter, by the percentage increase in the consumer price index for all urban consumers (all items; United States city average), rounded to the nearest one thousand dollars.
(B) This section does not apply to an individual if either of the following applies:
(1) Either of the following lawfully reside in the individual's home:
(a) The individual's spouse;
(b) The individual's child if the child is under twenty-one years of age or, under the "Social Security Act," section 1614, 42 U.S.C. 1382c, considered blind or disabled.
(2) The individual qualifies, pursuant to the process established under division (C) of this section, for a waiver of this section due to a demonstrated hardship.
(C) The director shall establish a process by which individuals may obtain a waiver of this section due to a demonstrated hardship. The process shall be consistent with the process for such waivers established by the United States secretary of health and human services under the "Social Security Act," section 1917(f)(4), 42 U.S.C. 1396p(f)(4).
(D) Nothing in this section shall be construed as preventing an individual from using a reverse mortgage or home equity loan to reduce the individual's total equity interest in the home.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5163 | Medicaid Eligibility › Section 5163.33 | Deducting Personal Needs Allowance From Recipient's Income.

Effective:
September 29, 2015
Latest Legislation:
House Bill 64 - 131st General Assembly
(A) In determining the amount of income that a medicaid recipient must apply monthly toward payment of the cost of care in a nursing facility or ICF/IID, a county department of job and family services shall deduct from the recipient's monthly income a monthly personal needs allowance in accordance with the "Social Security Act," section 1902(q), 42 U.S.C. 1396a(q).
(B) In the case of a resident of a nursing facility, the monthly personal needs allowance shall be not less than fifty dollars for an individual resident and not less than one hundred dollars for a married couple if both spouses are residents of a nursing facility and their incomes are considered available to each other in determining eligibility.
(C) In the case of a resident of an ICF/IID, the monthly personal needs allowance shall be as follows:
(1) Prior to January 1, 2016, forty dollars unless the resident has earned income, in which case the monthly personal needs allowance shall be determined by the department of medicaid, or the department's designee, but shall not exceed one hundred five dollars;
(2) For calendar year 2016 and each calendar year thereafter, not less than fifty dollars for an individual resident and not less than one hundred dollars for a married couple if both spouses are residents of an ICF/IID and their incomes are considered available to each other in determining eligibility.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5163 | Medicaid Eligibility › Section 5163.45 | Confinement of Medicaid Recipient in Correctional Facility.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
(A)(1) As used in this section, subject to division (A)(2) of this section, "state or local correctional facility" means any of the following:
(a) A "state correctional institution," as defined in section 2967.01 of the Revised Code;
(b) A "local correctional facility," as defined in section 2903.13 of the Revised Code;
(c) A correctional facility that is privately operated and managed pursuant to section 9.06 of the Revised Code.
(2) "State or local correctional facility" does not include any facility operated directly by or at the direction of the department of youth services.
(B) If a person who is confined in a state or local correctional facility was a medicaid recipient immediately prior to being confined in the facility, all of the following apply:
(1) The person's eligibility for medicaid while so confined shall be suspended due to the confinement.
(2) No medicaid payment shall be made for any care, services, or supplies provided to the person during the suspension described in division (B)(1) of this section.
(3) The suspension described in division (B)(1) of this section shall end upon the release of the person from the confinement.
(4) Except as provided in division (C) of this section, the person shall not be required to reapply or undergo a redetermination of eligibility for medicaid when the suspension described in division (B)(1) of this section ends.
(C) A person may be disenrolled from medicaid any time after the suspension described in division (B)(1) of this section ends if the person is no longer eligible for medicaid. A person may be required to undergo a redetermination of eligibility for medicaid any time after the suspension described in division (B)(1) of this section ends if it is time or past time for the person's eligibility redetermination or the person's circumstances have changed in a manner warranting a redetermination.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5164 | Medicaid State Plan Services › Section 5164.02 | Rules to Implement Chapter.

Effective:
September 29, 2017
Latest Legislation:
House Bill 49 - 132nd General Assembly
(A) The medicaid director shall adopt rules as necessary to implement this chapter. The rules shall be adopted in accordance with Chapter 119. of the Revised Code.
(B) The rules shall establish all of the following:
(1) The amount, duration, and scope of the medicaid services covered by the medicaid program;
(2) The medicaid payment rate for each medicaid service or, in lieu of the rate, the method by which the rate is to be determined for each medicaid service;
(3) Procedures for enforcing the rules adopted under this section that provide due process protections, including procedures for corrective action plans for, and imposing financial and administrative sanctions on, persons and government entities that violate the rules.
(C) The rules may be different for different medicaid services.
(D) The medicaid director is not required to adopt a rule establishing the medicaid payment rate for a medicaid service if the director adopts a rule establishing the method by which the rate is to be determined for the medicaid service and makes the rate available on the internet web site maintained by the department of medicaid.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5164 | Medicaid State Plan Services › Section 5164.03 | Mandatory and Optional Services.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
(A) The medicaid program shall cover all mandatory services.
(B) The medicaid program shall cover all of the optional services that state statutes require the medicaid program to cover.
(C) The medicaid program may cover any of the optional services to which either of the following applies:
(1) State statutes expressly permit the medicaid program to cover the optional service;
(2) State statutes do not address whether the medicaid program may cover the optional service.
(D) The medicaid program shall not cover any optional services that state statutes prohibit the medicaid program from covering.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5164 | Medicaid State Plan Services › Section 5164.06 | Medicaid Coverage of Occupational Therapy Services.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
The medicaid program shall cover occupational therapy services provided by an occupational therapist licensed under section 4755.08 of the Revised Code. Coverage shall not be limited to services provided in a hospital or nursing facility. Any licensed occupational therapist may enter into a provider agreement with the department of medicaid to provide occupational therapy services under the medicaid program.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5164 | Medicaid State Plan Services › Section 5164.061 | Chiropractic Services.

Effective:
June 13, 2022
Latest Legislation:
House Bill 136 - 134th General Assembly
(A) As used in this section:
(1) "Prescriber" has the same meaning as in section 4729.01 of the Revised Code, but does not include a dentist, optometrist, or veterinarian.
(2) "Prior authorization requirement" means any practice in which coverage of a health care service, device, or drug is dependent upon a recipient or health care practitioner obtaining approval from the medicaid program prior to the service, device, or drug being performed, received, or prescribed, as applicable.
(B)(1) The medicaid program shall cover evaluation and management services provided by a chiropractor if the chiropractor is licensed to practice chiropractic under Chapter 4734. of the Revised Code.
(2) The medicaid director may adopt rules under section 5164.02 of the Revised Code to cover other services provided by a chiropractor under the medicaid program.
(3) With respect to the coverage described in this section, all of the following apply:
(a) A chiropractor may provide covered services in any location, including a hospital or nursing facility.
(b) The medicaid program shall not impose a prior authorization requirement on covered services.
(c) The medicaid program shall not make coverage contingent upon the medicaid recipient first receiving a referral, prescription, or treatment from a prescriber.
(C) If a service described in this section could be provided by either a chiropractor licensed under Chapter 4734. of the Revised Code or a licensed health professional other than a chiropractor, the medicaid program shall pay the chiropractor the same amount for the service that it pays the licensed health professional.
Last updated March 22, 2022 at 2:03 PM