Ohio Administrative Code
Title 5160:1 - Eligibility
Chapter 5160:1-2 - Medicaid Application Procedures
Section 5160:1-2-08 - Medicaid: individual responsibilities
Universal Citation: OH Admin Code 5160:1-2-08
Current through all regulations passed and filed through September 16, 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.
(2) When applying for or receiving medical
assistance on the basis of being blind, disabled, or at least age sixty-five,
an individual must also inform the administrative agency of any:
(a) Improvement of the condition for which
the benefit is received; or
(b)
Change in the ownership or value of a resource owned by the individual or the
individual's spouse, including any change in an annuity or an annuity's
remainder beneficiary designation.
(C) Authorized representative.
(1) An individual may designate an authorized
representative, in writing, to stand in place of the individual and act with
authority on behalf of the individual, as described in rule
5160-1-33 of the Administrative
Code.
(2)
When an
individual is unable to identify an authorized representative because of
incapacity or incompetence, the administrative agency will assist the
individual with appointing an authorized representative, as described in rule
5160:1-2-01 of the
Administrative Code.
Disclaimer: These regulations may not be the most recent version. Ohio may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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