Ohio Administrative Code › Title 5160:1 - Eligibility › Chapter 5160:1-2 - Medicaid Application Procedures › Section 5160:1-2-08 - Medicaid: individual responsibilities

Current through all regulations passed and filed through July 1, 2024
(A) This rule describes the responsibilities
			 of an individual, or someone acting on an individual's behalf, who is
			 applying for or receiving medical assistance.
(B) Individual responsibilities.
(1) When applying for or receiving any
			 medical assistance, an individual must:
(a)
			 Sign, under penalty of perjury, and submit an application for medical
			 assistance in accordance with rule
			 5160:1-2-01 of the
			 Administrative Code.
(b) Cooperate
			 with the administrative agency in any eligibility determination for initial or
			 continuing coverage, audit, and quality control process set out in this chapter
			 of the Administrative Code. The individual must:
(i) In completing an application or renewal
			 for medical assistance, answer all required questions and provide documentation
			 requested by the administrative agency necessary to verify the conditions of
			 eligibility as described in rule
			 5160:1-2-10 of the
			 Administrative Code and any other relevant eligibility criteria required under
			 Chapter
			 5160:1-3,
			 5160:1-4,
			 5160:1-5, or
			 5160:1-6 of the Administrative
			 Code.
(ii) Request assistance from
			 the administrative agency when unable to obtain requested information. The
			 individual must provide the information necessary to allow the administrative
			 agency to assist the individual.
(c) Select a managed care
			 
										organization
										(MCO) as
			 required by rule
			 5160-26-02 of the Administrative
			 Code, unless the individual meets one of the exceptions listed in that
			 rule.
(d) Inform the administrative
			 agency within ten calendar days of any change to the following circumstances
			 for the individual or any person living with the individual:
(i)
											Contact
			 information.
(a)
												Address; or
(b)
												Phone number;
			 or
(c)
												Email address.
(ii)
											Marital
			 status.
(iii) Income,
			 including any:
(a)
												One-time gifts or payments; or
(b)
			 Change in hourly wage or salary; or
(c)
			 Change in full-time or part-time status; or
(d)
												Gain or
			 loss of employment.
(iv) An individual's
			 pregnancy status, such as an individual becoming pregnant or a pregnancy
			 ending.
(v) Third-party
			 responsibility for the individual's health care costs, including:
(a) New coverage under a health insurance
			 policy, regardless of who is paying for the coverage;
			 or
(b) A change in health insurers;
			 or
(c) Loss or ending of other health insurance
			 coverage; or
(d) A court order requiring a person or
			 entity to pay some or all of the individual's medical expenses; or
(e) Any accident or injury for which another
			 person or entity may be responsible, such as a work-related injury or an injury
			 received in an automobile collision. In addition to reporting the injury or
			 accident, an individual must also report any information received about any
			 involved insurance company.
(e)
			 Cooperate with any third party responsible for an individual's health care
			 costs.
(f) Not commit medicaid
			 eligibility fraud as described in section
			 2913.401 of the Revised
			 Code.