Current through all regulations passed and filed through September 16, 2024
(A)
This rule describes the requirements in section 1137 of
the Social Security Act (as in effect October 1, 2020) and in section
42 C.F.R.
435.945 (as in effect October 1, 2020),
requiring state agencies administering certain federally funded public
assistance programs to establish procedures for obtaining, using, and verifying
information relevant to determinations of eligibility. The Ohio department of
medicaid (ODM) shall obtain and share income and benefit information with the
following sources:
(1)
The social security administration
(SSA).
(2)
The internal revenue service (IRS).
(3)
The state wage
information collection agency (SWICA).
(4)
Agencies
administering unemployment compensation (UC) benefits.
(B)
Definition. "Income and eligibility verification system"
(IEVS) is defined in rule
5160:1-1-01
of the Administrative Code.
(C)
Administrative
agency responsibilities. Within forty-five days of receipt of the information,
the administrative agency shall initiate, pursue, and complete the actions
specified in this paragraph:
(1)
Provide adequate safeguards in accordance with rule
5160-1-32
of the Administrative Code.
(2)
Inform all
individuals in writing at the time of application and renewal that the agency
will obtain and use information available from IEVS data matches to verify
initial or ongoing eligibility for medicaid.
(3)
Review and
compare against the case record all information received from the IEVS data
matches to determine whether the information affects the individual's
eligibility, in accordance with
42 C.F.R.
435.948 (as in effect October 1,
2020).
(4)
Obtain additional information or documentation from the
individual, if needed, to determine eligibility and initiate appropriate action
in accordance with
42
C.F.R. 435.952(c) (as in
effect October 1, 2020).
(5)
Continue benefits while the steps listed in this rule
are being taken to verify the matched data in accordance with
42
C.F.R. 435.952(d) (as in
effect October 1, 2020). The administrative agency shall verify information
relating to:
(a)
The amount of the income and resource involved;
and
(b)
Whether the individual actually has or had access and
use of the resource, income, or both; and
(c)
The period of
time during which the individual actually has or had access to the resource,
income, or both.
(6)
Update case
information and redetermine eligibility when the verification received is
discrepant from the information currently listed in the electronic eligibility
system. The discrepancy threshold is determined by ODM.
Replaces: 5160:1-1-04
