Ohio Administrative Code › Title 5160:1 - Eligibility › Chapter 5160:1-6 - Long-Term Care › Section 5160:1-6-03.1 - Medicaid: determining financial eligibility for medical assistance using the special income level

Current through all regulations passed and filed through July 1, 2024
(A) This rule describes how to determine
			 financial eligibility for medical assistance using the special income level
			 (SIL). This rule does not describe how to determine nonfinancial eligibility
			 criteria for medical assistance or for medicaid payment of longterm care
			 services.
(B) An individual,
			 regardless of age, who is ineligible under base eligibility due to excess
			 income may be income eligible for medical assistance if his or her income is
			 less than or equal to the SIL. The SIL is equal to three hundred per cent of
			 the current supplemental security income (SSI) benefit payment rate for an
			 individual.
(C) An individual who
			 is income eligible under the SIL must also meet the resource requirements in
			 rules 5160:1-3-05.1 and
			 5160:1-6-04 of the
			 Administrative Code, as applicable, before his or her application for medical
			 assistance can be approved.
(D)
			 Only an individual who has been institutionalized for a continuous period of
			 institutionalization, as defined in rule
			 5160:1-6-01.1 of the
			 Administrative Code, may have his or her income eligibility determined using
			 the SIL.
(E) When the individual is
			 eligible under the SIL, eligibility for medical assistance will begin the first
			 day of the month in which the continuous period of institutionalization
			 began, and last, assuming all other eligibility
			 criteria are met, until the individual is no longer institutionalized or
			 receiving home and community-based (HCBS) or program of all-inclusive care for
			 the elderly (PACE) services.
(F) When the individual is eligible under the
			 SIL, the administrative agency shall calculate a patient liability in
			 accordance with rules
			 5160:1-6-07 and
			 5160:1-6-07.1 of the
			 Administrative Code, as applicable. The individual must pay the calculated
			 patient liability to the long-term care (LTC) provider as applicable.
(G) When an individual's countable income is
			 greater than the SIL, the individual may establish a qualified income trust
			 (QIT) in accordance with rule
			 5160:1-6-03.2 of the
			 Administrative Code to reduce his or her countable income to or below the
			 SIL.
(H) Determine whether an
			 individual's income is at or below the SIL as follows:
(1) Total only the individual's gross income,
			 earned and unearned as defined in rule
			 5160:1-1-01 of the
			 Administrative Code (do not include parental or spousal income), then exclude
			 the following income types:
(a) Payments not
			 considered income, in accordance with
			 20 C.F.R.
			 416.1103 (as in effect October 1,
			 2023),
			 which includes veterans administration aid and attendance.
(b) Payments to victims of Nazi
			 persecution.
(c) Austrian social
			 insurance payments based, in whole or in part, on wage credits received under
			 the provisions of the Austrian General Social Insurance Act, paragraphs 500
			 through 506 (as in effect October 1, 2023). These
			 payments need to be documented and identifiable separate from countable
			 insurance.
(d) Payments from the
			 Dutch government under the Netherlands' Benefit Act for victims of persecution
			 from 1940-1945 (Dutch acronym, WUV) (Pub. L. No.
			 103-286).
(e) Restitution payments under the Civil
			 Liberties Act of 1988, to U.S. citizens of Japanese ancestry and permanent
			 resident Japanese non-citizens who were interned during World War II, or their
			 survivors, in accordance with
			 50 U.S.C.
			 4215 (as in effect October 1,
			 2023).
(f)
			 Restitution payments under the Aleutian and Pribilof Island Restitution Act, in
			 accordance with 50 U.S.C.
			 4236 (as in effect October 1,
			 2023).
(g)
			 Agent Orange settlement fund payments received on or after January 1, 1989, as
			 a result of the Agent Orange Compensation Exclusion Act (Pub. L. No.
			 101-201).
(h) Department of defense payments to certain
			 persons captured and interned in North Vietnam, in accordance with the
			 Departments of Labor, Health and Human Services, and Education, and Related
			 Agencies Appropriations Act of 1998 (Pub. L. No.
			 105-78).
(i) Radiation exposure compensation trust
			 fund payments, in accordance with the Radiation Exposure Compensation Act of
			 1990 (Pub. L. No.
			 101-426).
(j) Veterans affairs payments made to or on
			 behalf of:
(i) Certain Vietnam veterans'
			 natural children regardless of age or marital status, for any disability
			 resulting from spina bifida suffered by such children;
(ii) Certain Korea service veterans' natural
			 children regardless of age or marital status, for any disability resulting from
			 spina bifida suffered by such children; and
(iii) The natural children, regardless of age
			 or marital status, with certain birth defects born to a woman who served in
			 Vietnam.
(k) Payments
			 made to Native Americans as listed in section IV of
			 20 C.F.R.
			 416 Subpart K Appendix (as in effect October
			 1, 2023).
(l)
			 Residential state supplement (RSS) payments to individuals, in accordance with
			 rule 5160:1-5-01 of the
			 Administrative Code.
(m) Payments
			 from a state compensation fund for victims of crime.
(n) Payments made from any fund established
			 pursuant to a class action settlement in the case of "Factor VIII or IX
			 concentrate blood products litigation," MDL986, no. 93-C-7452 (N.D. Ill), per
			 section 4735 of the Balanced Budget Act of 1997 (Pub. L. No.
			 105-33).
(o) Payments from the Ricky Ray Hemophilia
			 Fund Act of 1998 (Pub. L.
			 No. 105-369) or payments made from any fund
			 established pursuant to a class settlement in the case of Susan Walker v. Bayer
			 Corporation, 96-C-5024 (N.D. III).
(p) Payments made to individuals under the
			 Energy Employees Occupational Illness Compensation Program Act of 2000
			 (Pub. L. No.
			 106-398).
(q) Assistance (other than wages or salaries)
			 under the Older Americans Act of 1965 (Pub. L. No. 89-73).
(r) Student financial assistance received
			 under the Higher Education Act (HEA) of 1965 (as in effect October 1,
			 2023) or
			 bureau of Indian affairs is excluded from income, regardless of use:
(i) Pell grants;
(ii) Student services incentives;
(iii) Academic achievement incentive
			 scholarships;
(iv) Federal
			 supplemental education opportunity grants;
(v) Federal educational loans (Stafford
			 loans, William D. Ford federal direct and direct PLUS loans, etc.);
(vi) Upward bound;
(vii) Gear up (gaining early awareness and
			 readiness for undergraduate programs);
(viii) State educational assistance programs
			 funded by the leveraging education assistance programs; and
(ix) Work-study programs.
(s) Matching funds that are deposited into
			 individual development accounts (IDAs), either demonstration project or
			 TANF-funded, in accordance with
			 42 U.S.C.
			 604 (as in effect October 1,
			 2023).
(t)
			 Accounts under the Stephen Beck, Jr., Achieving a Better Life Experience (ABLE)
			 Act of 2014 (Pub. L. No.
			 113-295). The following are not considered income
			 to the account holder:
(i) Contributions to an
			 ABLE account by another individual or third party.
(ii) Interest earned on an ABLE
			 account.
(iii) Distributions from
			 an ABLE account.
(u)
			 Federal and state foster care payments received under title IV-B or title IVE
			 for a child currently living in the household.
(v) Federal or state adoption assistance
			 payments received under title IV-B or title IV-E.
(w) Payments received under the kinship
			 guardianship assistance program (KGAP), state KGAP, or kinship guardianship
			 assistance program connections to twenty-one (KGAP C21).
(x) Child care assistance under the Child
			 Care and Development Block Grant Act of 1990 (Pub. L. No. 113-186).
(y) Assistance or services received through
			 the domestic volunteer service under
			 42 U.S.C.
			 66 per
			 42 U.S.C.
			 5044(f) (as in effect
			 October 1, 2023).
(z)
			 Payments made for supporting services or reimbursement of out-of-pocket
			 expenses to volunteers participating in corporation for national and community
			 services (CNCS, formerly ACTION) programs in accordance with
			 42 U.S.C.
			 1382a (as in effect October 1,
			 2023):
(i) AmeriCorps VISTA program;
(ii) Special and demonstration volunteer
			 programs;
(iii) Retired senior
			 volunteer program (RSVP);
(iv)
			 Foster grandparents program; and
(v) Senior companion program.
(aa) Assistance or services
			 received through federal food and nutrition programs:
(i) Supplemental nutrition assistance program
			 (SNAP);
(ii) The value of foods
			 donated by the U.S. department of agriculture commodity supplemental food
			 program;
(iii) The value of
			 supplemental food assistance received under the Child Nutrition Act of 1966
			 (Pub. L. No.
			 89-642) and the special food service program for
			 children under the National School Lunch Act (Pub. L. No. 90-302);
(iv) The special supplemental nutrition
			 program for women, infants, and children (WIC); and
(v) Nutrition program benefits provided for
			 the elderly under Title VII of the Older Americans Act of 1965 (Pub. L. No.
			 89-73).
(bb) Assistance received under the Robert T.
			 Stafford Disaster Relief and Emergency Assistance Act (Pub. L. No.
			 100-707) and assistance provided under any federal
			 statute because of a presidentially-declared disaster.
(cc) Assistance, with respect to the dwelling
			 unit occupied by such individual (or such individual and spouse), under the
			 United States Housing Act of 1937 (Pub. L. No. 75-412), the
			 National Housing Act (Pub.
			 L. No. 73-479), section 101 of the Housing and
			 Urban Development Act of 1965 (Pub. L. No. 89-117), title V of
			 the Housing Act of 1949 (Pub. L. No. 81-171), or section 202(h) of the Housing
			 Act of 1959 (Pub. L. No.
			 86-372).
(dd) Home energy assistance provided on the
			 basis of need, in accordance with
			 20 C.F.R.
			 416.1157 (as in effect October 1,
			 2023).
(ee) Relocation assistance provided under
			 title II of the Uniform Relocation Assistance and Real Property Acquisitions
			 Policies Act of 1970 (Pub.
			 L. No. 91-646) provided to individuals displaced
			 by or through any federal, federally-assisted, state, state-assisted, local, or
			 locally-assisted government project in the acquisition of real
			 property.
(ff) The first two
			 thousand dollars per calendar year received as compensation for participation
			 in clinical trials that meet the criteria detailed in section 1612(b) of the
			 Social Security Act (as in effect October 1, 2023).