Ohio Administrative Code › Title 5160:1 - Eligibility › Chapter 5160:1-5 - Medicaid for Other Covered Groups › Section 5160:1-5-03 - Medicaid: medicaid buy-in for workers with disabilities (MBIWD)

Current through all regulations passed and filed through July 1, 2024
(A) This rule
			 governs the eligibility requirements for the medical assistance programs
			 authorized under sections 1902(a)(10)(A)(ii)(XV) and (XVI) of the Social
			 Security Act (as in effect October 1, 2023). Medicaid
			 buy-in for workers with disabilities (MBIWD) enables certain individuals to
			 increase their income and resources without the risk of losing medical
			 assistance coverage.
(B)
			 Definitions.
(1) "Basic covered group" means
			 the individuals meeting all criteria in paragraph (C)(1) of this
			 rule.
(2) "Blind work expense
			 (BWE)" has the same meaning as in rule
			 5160:1-3-03.2 of the
			 Administrative Code.
(3) "Countable
			 income," for the purpose of this rule, means income less exclusions.
(4) "Countable resources", for the purpose of
			 this rule, means those resources remaining after all exclusions have been
			 applied.
(5)
									"Family," for the purpose of this rule, means an
			 individual, the individual's spouse, and dependent children living in the
			 household of the individual. 
									When an individual is younger than eighteen years
			 of age, "family" also means the individual's parents.
(6) "Impairment-related work expense (IRWE)"
			 as defined in 20 C.F.R.
			 404.1576 (as in effect October 1,
			 2023).
(7)
									"Income," for the purpose of this rule, means gross
			 earned income and gross unearned income.
(8)
									"Individual," for the purpose of this rule, means the
			 applicant for or recipient of MBIWD.
(9) "Individual with a medically improved
			 disability" means an individual who is a recipient of MBIWD in the basic
			 covered group but who no longer meets the disability criterion as defined in
			 paragraph (C)(1)(b) of this rule.
(10) "Medicaid buy-in for workers with
			 disabilities (MBIWD)" means the component of the medicaid program established
			 under sections 5163.09 to
			 5163.098 of the Revised Code and
			 includes the basic covered group and the medically improved covered
			 group.
(11) "Medical and remedial
			 expense (MRE)" means an incurred expense for care, services, or goods
			 prescribed or provided by a licensed medical practitioner within the scope of
			 practice as defined under state law. This expense is the responsibility of the
			 individual, and cannot be reimbursed by any other source, such as medicaid,
			 private insurance, or an employer.
(12) "Medical insurance premiums" means the
			 amount paid for insurance coverage for medical items or services such as
			 health, dental, vision, long-term care, hospital, prescriptions, etc.
(13) "Medically improved covered group" means
			 the individuals meeting all criteria in paragraph (C)(2) of this
			 rule.
(14) "Premium" means a
			 periodic payment required under section
			 5163.094 of the Revised Code and
			 described in paragraph (E) of this rule.
(15) "Resource eligibility limit for MBIWD"
			 means countable resources limited to the amount specified under section
			 5163.092 of the Revised
			 Code.
(16) "Social security
			 disability insurance (SSDI)" means the program established under Title II of
			 the Social Security Act (as in effect October 1, 2023).
(17) "Supplemental security income (SSI)"
			 means the program established under Title XVI of the Social Security Act (as in
			 effect October 1, 2023).
(18) "Work" or "working", for the purpose of
			 this rule, means full- or part-time employment or self-employment from which
			 state or federal income and payroll taxes are paid or withheld.