Ohio Administrative Code
Title 5160:1 - Eligibility
Chapter 5160:1-1 - General Medicaid Eligibility Policy
Section 5160:1-1-01 - Medicaid: definitions
Universal Citation: OH Admin Code 5160:1-1-01
Current through all regulations passed and filed through September 16, 2024
(A) This rule contains definitions generally used in determining eligibility for medical assistance.
(B) Definitions.
(1) "Abuse" means any action by an individual
or entity that results in unnecessary costs to the medical assistance program
in accordance with 42 C.F.R
455.2 (as in effect October 1,
2022).
(2)
"Administrative agency" means the Ohio department of medicaid (ODM) and/or an
agent of ODM authorized to determine eligibility for a medical assistance
program.
(3) "Advance notice of
adverse action" means a written notice of the administrative agency's intent to
discontinue or suspend medical assistance, reduce the level of benefits or
covered services, or increase the amount of an individual's premium or patient
liability, sent no less than fifteen calendar days prior to the date of the
proposed action in accordance with rules
5101:6-2-04 and
5101:6-2-05 of the
Administrative Code.
(4)
"Applicant" means an individual who is seeking an eligibility determination for
himself or herself through an application submission or a transfer from another
agency or insurance affordability program in accordance with
42 C.F.R.
435.4 (as in effect October 1,
2022).
(5)
"Approve" or "approval" means a determination by the administrative agency that
an individual is eligible for one or more categories of medical assistance
applied for by the individual or on behalf of the individual by his or her
authorized representative.
(6)
"Assets" means all income and resources of the individual and of the
individual's spouse. This includes any income or resources the individual or
the individual's spouse is entitled to, but does not receive, because of an
action taken to avoid receipt of the asset by:
(a) The individual or the individual's
spouse; or
(b) A person, including
a court or administrative body, with legal authority to act in place of, or on
behalf of, the individual or the individual's spouse; or
(c) Any person, including any court or
administrative body, acting at the direction, or upon the request, of the
individual or the individual's spouse.
(7) "Assignment" means an individual eligible
for medical assistance has transferred his or her right, or the rights of any
other individual for whom he or she can legally make an assignment, to collect
and retain third-party and/or medical support payments to ODM up to the amount
of medical services paid under the medicaid program.
(8) "Authorized representative" means a
person, who is at least eighteen years of age, or a legal entity who stands in
place of the individual. Actions or failures of an authorized representative
will be accepted as the action or failure of the individual. When an individual
has designated an authorized representative, all references to the individual's
responsibilities include the authorized representative in accordance with rule
5160-1-33 of the Administrative
Code.
(9) "Base eligibility" means
the individual meets all of the eligibility requirements for at least one
category of medical assistance described in Chapter 5160:1-3, 5160:1-4, or
5160:1-5 of the Administrative Code.
(10) "Caretaker relative" means a relative of
a dependent child by blood, adoption, or marriage with whom the child is
living, who assumes primary responsibility for the child's care (as may, but is
not required to, be indicated by claiming the child as a tax dependent for
federal income tax purposes), and who is one of the following:
(a) The child's father, mother, brother,
sister, stepfather, stepmother, stepbrother, or stepsister; or
(b) The child's grandfather, grandmother,
uncle, aunt, nephew, or niece, including such relatives with the prefix great,
great-great, grand, or great-grand; or
(c) The child's first cousin or first cousin
once removed; or
(d) The spouse of
such parent or relative, even after the marriage is terminated by death or
divorce.
(11) "Case
record" means electronic or paper documents and information used to determine,
redetermine, or renew an individual's eligibility for medical
assistance.
(12) "Creditable
insurance" or "creditable coverage" means health insurance coverage as defined
in 42 U.S.C.
300gg-3(c) (as in
effect October 1,
2022).
(a) This
includes:
(i) A group health plan;
or
(ii) Health insurance coverage;
or
(iii) Medicare part A, as set
forth in 42 U.S.C.
1395c to
1395i-5 (as in effect October 1,
2022) or
part B, as set forth in 42
U.S.C. 1395j to
1395w-6 (as in effect October 1,
2022);
or
(iv) Coverage under medicaid, as
set forth in Title XIX of the Social Security Act, other than coverage
consisting solely of benefits under the pediatric vaccine program set forth in
42 U.S.C.
1396s (as in effect October 1,
2022);
or
(v) Armed forces health
insurance as set forth in 10
U.S.C. 1071 to
1110b (as in effect October 1,
2022);
or
(vi) A medical care program of
the Indian health service or of a tribal organization; or
(vii) A state health benefits risk pool;
or
(viii) A federal employee health
plan offered under 5 U.S.C.
8901 to
8992 (as in effect October 1,
2022);
or
(ix) A public health plan;
or
(x) A peace corps volunteer
health benefit plan under section
22 U.S.C.
2504 (as in effect October 1,
2022).
(b) Creditable insurance does not include:
(i) Coverage only for accident or disability
income insurance; or
(ii) Liability
insurance, including general liability insurance and automobile liability
insurance, or coverage issued as a supplement to liability insurance;
or
(iii) Workers' compensation or
similar insurance; or
(iv)
Automobile medical payment insurance; or
(v) Credit insurance which pays off existing
debts in the event of death, disability, or unemployment; or
(vi) Coverage for employment onsite medical
clinics; or
(vii) Other similar
insurance coverage under which benefits for medical care are secondary or
incidental to other insurance benefits; or
(viii) Limited-scope dental or vision
benefits; or
(ix) Benefits for
long-term care, nursing facility care, home health care, or community-based
care; or
(x) Coverage only for a
specified disease or illness; or
(xi) Hospital indemnity or other fixed
indemnity insurance, if purchased separately; or
(xii) Medicare supplemental health insurance
as defined under 42 U.S.C.
1395ss (as in effect October 1,
2022),
coverage supplemental to the coverage provided to military or former military
personnel under 10 U.S.C.
1071 to
1110b (as in effect October 1,
2022),
and similar supplemental coverage provided to coverage under a group health
plan; or
(xiii) Coverage through a
medical cost-sharing program, including a health care cost-sharing
ministry.
(13) "Deduction" means a verifiable amount
the individual pays for an expense. Garnishments or liens placed against earned
or unearned income of an individual are not considered a deduction, regardless
of the reason for the garnishment or lien.
(14) "Deny" or "denial" means a determination
by the administrative agency that an individual is not eligible for one or more
categories of medical assistance applied for by the individual or on behalf of
the individual by his or her authorized representative.
(15) "Dependent child" means a person younger
than age eighteen living with a parent or caretaker relative.
(16) "Discontinue" or "discontinuance" means
a determination by the administrative agency that an individual is no longer
eligible, or has failed to cooperate with verification of eligibility, for one
or more categories of medical assistance currently being received by that
individual, resulting in a written notice of the administrative agency's
intention to end coverage under that category and providing notice of hearing
rights in accordance with 42
C.F.R. 435.917 (as in effect October 1,
2022).
(17) "Disregard" means the amount subtracted
from gross, non-excluded income in the medical assistance budget
calculation.
(18) "Early and
periodic screening, diagnostic and treatment" (EPSDT) means screening, vision,
dental, and hearing services, and such other necessary health care, diagnostic
services, treatment, and other measures described in
42 U.S.C.
1396d (as in effect October 1,
2022) to
correct or ameliorate defects and physical and mental illnesses and conditions
discovered by the screening services, whether or not such services are covered
under the medicaid state plan. Healthchek is Ohio's EPSDT program.
(19) "Earned income" means income in cash or
in-kind received as payment for services performed as an employee or as a
self-employed individual. Earned income includes but is not limited to wages,
salary, or commissions from which state or federal income taxes are paid or
withheld.
(20) "Electronic
equivalent" means an electronic version of an Ohio department of job family
services (ODJFS) or ODM form or application which has not been modified in any
way, other than format, prior to completion and submission of that form to the
administrative agency. The administrative agency is not required to accept
forms that are altered.
(21)
"Electronic protected health information" (ePHI) means any protected health
information (PHI) that is maintained or transmitted in electronic form,
regardless of the format.
(22)
"Electronic signature" means an electronic sound, symbol, or process attached
to, or logically associated with, a record and executed or adopted by a person
with the intent to sign the record as defined in section
1306.01 of the Revised
Code.
(23) "Encumbrance" means a
claim, lien, charge, or liability attached to and binding on an identified
piece of real or personal property.
(24) "Equity value" means the fair market
value of a resource minus any encumbrance.
(25) "Erroneous payment" means a medicaid
reimbursement made for an individual who was ineligible at the time services
were received, regardless of the presence of fraud or abuse.
(26) "Excluded income" means income that
state or federal law prohibits from consideration in determining eligibility
for medical assistance.
(27) "Fair
market value" means, unless otherwise stated, the going price, at the time of
the transfer or contract of sale, for which real or personal property can
reasonably be expected to sell on the open market in the relevant geographic
area. The appraised value of real property is determined by the county auditor
and may be used to establish fair market value.
(28) "Family size" means the number of
persons counted as members of an individual's medicaid household.
(29) "Federal adoption assistance" (AA) means
the Title IV-E subsidy program as defined by the Adoption Assistance and Child
Welfare Act of 1980 (Pub.
L. No. 96-272).
(30) "Federal benefit rate" (FBR) means the
supplemental security income (SSI) current payment standard published annually
by the social security administration (SSA).
(31) "Federal foster care maintenance" (FCM)
means the Title IV-E program, as described in rule
5101:2-47-01 of the
Administrative Code.
(32)
"Federal kinship guardianship assistance program"
(KGAP) means the Title IVE program to provide payments to relatives, as defined
in section 5101.141 of the Revised Code,
who have assumed legal custody or guardianship of eligible children whom they
have cared for as foster parents for a minimum of six consecutive months and
for whom there is a valid KGAP or KGAP C21 agreement.
(33)
"Federal means-tested public benefit" means a benefit in which eligibility for
the benefit or the amount of the benefit, or both, is determined on the basis
of income or resources of the individual seeking the benefit. Medicaid, cash
assistance, and food assistance are federal means-tested public benefits, but
certain other benefits listed in
8 U.S.C.
1613(c) (as in effect
October 1,
2022) are not considered means-tested.
(34)
"Federal poverty level" (FPL) means a measure of income determined annually by
the department of health and human services (HHS). The FPL is designed to
provide a baseline for determining financial eligibility for federal programs
and benefits.
(35) "Good cause"
means circumstances that reasonably prevent an individual from cooperating with
the administrative agency in the eligibility determination process. Factors
relevant to good cause include, but are not limited to, natural disasters,
riots or civil unrest, death or serious illness of the individual or a member
of his/her immediate family, or the physical, mental, educational, or
linguistic limitations of the individual.
(36) "Gross income"
means income prior to any deductions or disregards, with the exception of
self-employment gross countable income.
(37) "Health Insurance
Portability and Accountability Act of 1996" (HIPAA) means a federal law to
protect patient privacy, to protect security of electronic medical records, to
prescribe methods and formats for exchange of electronic medical information,
and to uniformly identify providers.
(38) "Immigrant" means
a person who comes to the United States (U.S.) with plans to live in the
country permanently. This term includes, but is not limited to, an individual
who is a refugee, asylee, parolee, or other entrant regardless of whether he or
she is residing in the U.S. legally.
(39) "Income" means
cash, in-kind income as defined in paragraph(B)(43) of this rule, or something of value which is
received, available, and attributable to an individual. Income includes the
receipt of any item which can be applied, either directly or by sale or
conversion, to meet the needs of an individual.
(40) "Income and
eligibility verification system" (IEVS) means the electronic system that shares
income and asset information among the social security administration (SSA),
internal revenue service (IRS), state wage information collection agency
(SWICA), agencies administering unemployment compensation (UC) benefits, and
the administrative agency.
(41) "Individual"
means a person applying for or receiving medical assistance.
(42)
"Individually identifiable health information" means information that is a
subset of health information that includes demographic information collected
from an individual and:
(a) Is created or
received by a health care provider, health plan, employer, or health care
clearinghouse; and
(b) Relates to
the past, present, or future physical condition or mental health condition of
an individual, the provision of health care to an individual, or the past,
present, or future payment for the provision of health care to an individual
and either:
(i) Identifies the individual;
or
(ii) There is a reasonable basis
to believe the information can be used to identify the individual.
(43) "In-kind income"
means any benefit received other than cash such as food, shelter, or something
that can be used to get food or shelter.
(44)
"Institution for mental diseases" (IMD) means a hospital, nursing facility, or
other institution of more than sixteen beds which primarily provides diagnosis,
treatment, or care of persons with mental diseases, including medical
attention, nursing care, and related services.
(a) A facility is an IMD, whether or not it
is licensed as such, if it is operated primarily for the care and treatment of
individuals with mental diseases.
(b) An institution for persons with cognitive
impairments or other developmental disabilities is not an IMD.
(45) "Lawfully
residing" means a qualified non-citizen immigration status granted to an
individual allowing him or her to live and/or work in the United
States.
(46) "Legal custodian"
means a person who has legal rights to have physical care and control of a
child, as defined in section
2151.011 of the Revised
Code.
(47) "Legal guardian"
means any person, association, or corporation appointed by a probate court to
exercise care and management of an individual, his or her estate, or both, as
defined in section 2111.01 of the Revised
Code.
(48) "Limited English
proficiency" (LEP) means the inability of any person or group of persons to
speak, read, write, or understand the English language at a level that allows
them to meaningfully communicate with the administrative agency.
(49)
"Liquid resource" means cash or property immediately convertible to
cash.
(50) "Lump-sum" means
a non-recurring payment received in a single amount, as opposed to smaller
payments over time.
(51) "Managed care
organization" (MCO) has the same meaning as in rule
5160-26-01 of the Administrative
Code.
(52) "Medicaid buy-in
for workers with disabilities" (MBIWD) as set forth in rule
5160:1-5-03 of the
Administrative Code, is a category of medical assistance that enables workers
with disabilities to earn income and have resources, not to exceed the limits
established by the state, without the risk of losing health care
coverage.
(53) "Medicaid
eligibility fraud" means an intentional deception or misrepresentation made by
a person with the knowledge that the deception could result in an unauthorized
benefit to himself, herself, or some other person in accordance with
42 C.F.R.
455.2 (as in effect October 1,
2022).
It includes any act that constitutes fraud under applicable federal or state
law.
(54) "Medicaid
household" means a group of individuals, defined in relationship to one
specific medical assistance applicant or recipient, who impact the applicant's
or recipient's family size, household income, or both.
(55)
"Medical assistance" includes all programs administered by the state medicaid
administrative agency.
(56) "Medical support"
means an order by a court to provide medical coverage.
(57)
"Medical verification of pregnancy" means a written statement signed by a
licensed medical professional verifying pregnancy and includes the expected
date of delivery and, if more than one, the expected number of
fetuses.
(58) "Minor child"
means a person younger than age eighteen.
(59) "Modified
adjusted gross income" (MAGI or MAGI-based income) means the income methodology
used for determining medical assistance eligibility for children through age
eighteen, parents, caretaker relatives, pregnant women, and adults age nineteen
through sixty-four.
(60) "Non-applicant"
means a person who is not seeking an eligibility determination for himself or
herself but is included in an applicant's or recipient's medicaid household to
determine eligibility for such applicant or recipient.
(61)
"Non-citizen emergency medical assistance" (NCEMA) as established in rule
5160:1-5-06 of the
Administrative Code, means time-limited coverage of an emergency medical
condition for certain individuals who do not meet the citizenship or
satisfactory immigration status requirements.
(62) "Non-cooperation"
or "failure to cooperate" means failure by an individual to present required
verification, or to explain why it is not possible to present the verification,
after being notified the verification was required for eligibility
determination.
(63) "Non-excluded
income" means income (earned or unearned) that is used in the eligibility
determination for medical assistance.
(64) "Outstationing"
means the federal requirement as described in
42 C.F.R.
435.904 (as in effect October 1,
2022)
that administrative agencies provide opportunities for low-income pregnant
women and children to apply for medical assistance at locations other than the
local county department of job and family services.
(65) "Parent" means a
natural, adoptive, or step-parent.
(66) "Personal
property" means any property that is not real property, as defined in paragraph
(B)(75)) of this rule. Personal property
includes, but is not limited to, such things as cash, jewelry, household goods,
tools, life insurance policies, automobiles, and promissory notes.
(67)
"Postpartum period" means the maximum permitted period of coverage as described
in 42 U.S.C.
1396a(e) (as in effect
October 1,
2022).
(68) "Pre-termination
review" (PTR) means a review of eligibility criteria completed prior to each
discontinuance of medical assistance, to determine whether an individual is
eligible for any other category of medical assistance in accordance with
42 C.F.R.
435.916(f)(1) (as in effect
October 1,
2022). Home and community-based services (HCBS), as
defined in rule
5160:1-6-01.1 of the Administrative Code,
the specialized recovery services (SRS) program described in rule
5160:1-5-07 of the
Administrative Code, or both will be explored as part of the PTR process when:
(a) The individual or his or her authorized
representative has requested HCBS or SRS; or
(b) The individual's case record contains
information indicating that he or she may be eligible for or in need of HCBS or
SRS. Receipt of SSI, social security disability insurance (SSDI), or any other
income type resulting from an individual's disability is not sufficient, by
itself, to demonstrate potential eligibility for or need of HCBS or SRS. There
must be additional factors in the case record that indicate the individual's
potential eligibility for or need of HCBS or SRS.
(69)
"Private child placing agency" (PCPA) means any association that is certified
to accept temporary, permanent, or legal custody of children and place the
children for foster care or adoption, as defined in rule
5101:2-1-01 of the
Administrative Code.
(70) "Protected health
information" (PHI) means individually identifiable health information that is
transmitted by electronic media, maintained in electronic media, or transmitted
or maintained in any other form or medium.
(71) "Public children
services agency" (PCSA) means an entity that has assumed the powers and duties
of the children services function for a county, as defined in rule
5101:2-1-01 of the
Administrative Code.
(72) "Public
institution" means an institution, as defined in
42 C.F.R.
435.1010 (as in effect October 1,
2022),
that is the responsibility of a governmental unit or over which a governmental
unit exercises administrative control, such as a state or federal prison, local
jail, detention facility, or other penal setting. Public institution does not
include a medical institution, an intermediate care facility, a publicly
operated community residence that serves no more than sixteen residents, or a
child care institution.
(73) "Qualified
entity" means the source of eligibility determinations for the presumptive
eligibility program and is limited to the following:
(a) A county department of job and family
services (CDJFS); or
(b) A
hospital, the Ohio department of rehabilitation and correction (DRC), or the
Ohio department of youth services (DYS); or
(c) A federally qualified health center
(FQHC) or an FQHC look-alike that meets the requirements described in Chapter
5160-28 of the Administrative Code; or
(d) A local health department, a special
supplemental nutrition program for women, infants, and children (WIC) clinic,
or other entity as designated by the director.
(74)
"Recipient" means an individual who has been determined eligible and is
currently receiving medical assistance in accordance with
42 C.F.R.
435 (as in effect October 1,
2022).
(75) "Real property"
means land, including buildings or immovable objects attached permanently to
the land.
(76) "Refugee" means a
person who flees his or her country due to persecution or a well-founded fear
of persecution because of race, religion, nationality, political opinion, or
membership in a social group and is admitted to the United States under Section
207 of the Immigration and Nationality Act (INA),
8 U.S.C.
1157 (as in effect October 1,
2022).
(77) "Redetermination"
means acting upon new or changed information received after an individual's
eligibility has been determined but prior to the regularly scheduled annual
renewal.
(a) The administrative agency shall
only redetermine eligibility using the new or changed information. All other
factors of eligibility not affected by the new or changed information are
presumed unchanged.
(b) The
original renewal date is not changed when eligibility has been redetermined,
unless the administrative agency has sufficient information regarding all
eligibility factors to renew eligibility without requesting additional
information from the individual.
(78) "Renew" or
"renewal" means a review of eligibility factors to determine whether the
individual continues to meet all of the criteria of a medical assistance
category. A renewal is performed annually.
(79) "Reporting" means
notifying the administrative agency of any changes that may affect an
individual's eligibility for medical assistance. Reporting changes and
providing verifications is the responsibility of any individual, person, or
entity who has a legal or financial responsibility for, or who stands in the
place of, an individual, including:
(a) The
individual; and
(b) The
individual's spouse, including a community spouse; and
(c) The individual's parent, legal custodian,
legal guardian, or caretaker relative; and
(d) The individual's authorized
representative.
(80) "Residence" means
the place the individual considers his or her established or principal home and
to which, if absent, he or she intends to return.
(81) "Residential care
facility" (RCF) means a home that provides either of the following as described
in section 3721.01 of the Revised Code:
(a) Accommodations for seventeen or more
unrelated individuals and supervision and personal care services for three or
more of those individuals who are dependent on the services of others by reason
of age or physical or mental impairment; or
(b) Accommodations for three or more
unrelated individuals, supervision and personal care services for at least
three of those individuals who are dependent on the services of others by
reason of age or physical or mental impairment, and, to at least one of those
individuals, any of the skilled nursing care authorized by section
3721.011 of the Revised
Code.
(82) "Resources" means
cash, funds held within a financial institution, investments, personal
property, and real property an individual and/or the individual's spouse has an
ownership interest in, has the legal ability to access in order to convert to
cash, and is not legally prohibited from using for support and
maintenance.
(83) "Safeguarding"
means security measures taken to ensure that the information of individuals
applying for or receiving medical assistance is protected against unauthorized
inspection, disclosure, or use. Safeguarding also refers to the restriction on
the use, or disclosure, of individual information including federal tax
information (FTI), any protected health information (PHI), or other
confidential information used in the administration of the medicaid program in
accordance with rule
5160-1-32 of the Administrative
Code.
(84)
"Self-attestation" or "self-declaration" means a statement of factual
information made by an individual.
(85) "Self-Employment
gross countable income" means the income from a business minus the expenses
directly related to producing the goods or services, and without which the
goods or services could not be produced.
(a)
When the individual has filed taxes for the previous year, use all tax forms
that were filed with the internal revenue service (IRS) to determine his or her
self-employment gross countable income.
(b) When the individual has not filed taxes
for the previous year, the following may be used to determine his or her
self-employment gross countable income:
(i)
Business records including receipts for the costs of doing business;
or
(ii) Estimate of anticipated
income and expenses.
(86) "Spouse" means a
person who is legally married to another under Ohio law.
(87)
"State adoption assistance" means the state-only adoption subsidy program as
described in rule
5101:2-44-03 of the
Administrative Code.
(88) "State foster
care maintenance" means an entitlement for financial assistance for state-only
foster care services as described in Chapter 5101:2-7 of the Administrative
Code.
(89) "Support
Services" means non-medical services offered or provided by the administrative
agency to assist the individual and may include arranging or providing
transportation, making medical appointments, accompanying the individual to
medical appointments, and making referrals to community and other social
services to be coordinated with the individual's medicaid-contracted managed
care organization (MCO), where applicable.
(90) "Suspend" or
"suspended" means the temporary discontinuance of eligibility.
(91)
"Temporary absence" means that an individual is considered not to have changed
residence and intends to return.
(a) An
individual is considered to be temporarily absent with no time limit when all
of the following conditions are met:
(i) The
location of the absent individual is known; and
(ii) There is a definite plan for the return
of the absent individual to the residence; and
(iii) The absent individual lived in the
residence immediately prior to the absence, except for individuals described in
paragraph (C)(1)(h) of rule
5160:1-4-02 of the
Administrative Code.
(b)
Child(ren) removed by the PCSA are considered temporarily absent as long as the
reunification requirements specified in the reunification plan are
met.
(92) "Terminate" or
"terminated" has the same meaning as "discontinue" or "discontinuance" as
defined in paragraph (B)(16) of this rule.
(93) "Unearned income"
means all income that is not earned income as defined in paragraph (B)(19) of
this rule.
(94) "United States
(U.S.)" and "state(s)" mean all fifty U.S. states, the District of Columbia,
and the U.S. territories of American Samoa, Guam, the Northern Mariana Islands,
Puerto Rico, Swain's Island, and the U.S. Virgin Islands.
(95)
"United States citizen or national" means any individual who is:
(a) A citizen or national through birth or
collective naturalization as set forth in 8 U.S.C. Chapter 12, Subchapter III,
Part I (as in effect October 1,
2022); or
(b) A naturalized citizen or national as set
forth in 8 U.S.C. Chapter 12, Subchapter III, Part II (as in effect October 1,
2022).
(96) "Verification"
means a document, statement, electronic validation, or other type of
information provided by an individual or by a third party to confirm statements
made by the individual regarding any requirement for eligibility for medical
assistance. A verification document or written statement may be an original,
photocopy, facsimile (fax), or electronic version of the original, unless
otherwise stated.
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