Ohio Administrative Code
Title 5160:1 - Eligibility
Chapter 5160:1-2 - Medicaid Application Procedures
Section 5160:1-2-12 - Medicaid: non-citizens
Universal Citation: OH Admin Code 5160:1-2-12
Current through all regulations passed and filed through September 16, 2024
(A) This rule sets forth:
(1)
Medical assistance eligibility criteria for an individual
who is not a U.S. citizen or national; and
(2)
Acceptable
documentary evidence of qualified non-citizen status; and
(3)
The circumstances
under which an individual who declares qualified non-citizen status, under
penalty of perjury, may be given a reasonable opportunity to verify that
status.
(B) Definitions. For the purposes of this rule:
(1) "A-number" means the alien registration
number issued to a non-citizen by the United States citizenship and immigration
service (USCIS) or, in limited circumstances, by the United States department
of state.
(2) "Active duty" means
full-time employment in the military service, and does not include reserve or
guard duty. The service member shall serve a minimum of twenty-four months or
the period for which the person was called to military service in order to be
eligible for benefits that are based on the length of active duty
service.
(3) "Amerasian" means
a
person born in Cambodia, Korea, Laos, Thailand, or Vietnam after December
31, 1950, and before October 22, 1982, who was fathered by a U.S.
citizen.
(4) "Asylee" means a
person who has been granted asylum under section 208 of the Immigration and
Nationality Act (INA) (as in effect October 1, 2019).
(5) "Child" means an individual under the age
of twenty-one.
(6) "Indefinite
detainee" means a non-citizen who has served time for a criminal conviction and
has received a final order of removal, but remains indefinitely in the United
States because neither the individual's home country nor any other country will
accept the individual. Being an indefinite detainee does not confer
eligibility
for medical assistance upon an individual nor
does it serve as an exemption to the five-year bar described in paragraph
(C)(3) of this rule.
(7) "Lawful permanent resident" (LPR) means
a
person who is legally authorized to live
permanently within the United States as an immigrant
.
(8) "Parolee" means a person who has been
given permission by the United States department of justice or the United
States department of homeland security to enter the United States in an
emergency or because it serves an overriding public interest. Parolees are
granted temporary residence and are not on a predetermined path to permanent
resident status.
(9) "Qualified
non-citizen" means:
(a) An LPR;
or
(b) An asylee who has
been granted asylum under section 208 of the Immigration and Nationality Act
(INA) (as in effect October 1, 2019); or
(c) A
refugee admitted to the United States under section 207 of the INA (as in
effect October 1, 2019); or
(d) A
parolee allowed into the United States under section 212(d)(5) of the INA (as
in effect October 1, 2019) for a period of at least one year;
or
(e)
A person whose deportation is being
withheld under section 243(h) of the INA (as in effect prior to April 1,
1997) or whose removal has been withheld under section 241(b)(3) of the
INA (as in effect October 1, 2019);
or
(f)
A person granted conditional
entry pursuant to section 203(a)(7) of the INA (as in effect prior to April 1,
1980); or
(g) A Cuban or Haitian entrant as defined in
section 501(e) of the Refugee Education Assistance Act of 1980;
or
(h) An Amerasian immigrant
as defined in Section 584 of the Foreign Operations,
Export Financing, and Related Programs Appropriations Act of 1988 ( Pub. L. No.
100-202); or
(i)
A non-citizen or non-citizen's child
who has been battered or subjected to extreme cruelty in the United States
under Section
501 of
Pub.
L. No. 104-208, under certain circumstances as
defined in
8
U.S.C. 1641(c)
(as in
effect October 1, 2019); or
(j) An Afghan or Iraqi non-citizen granted
special immigrant visa status under Section 8120 of the
December 19, 2009 Defense Appropriations Bill (Pub.
L. No. 111-118) and section 101(a)(27) of
the INA (as in effect October 1, 2019).
(10)
"Quarter of coverage" is the basic unit for determining whether a worker is
insured under the social security program. The amount of wages and
self-employment income which an individual shall have in order to be credited
with a quarter of coverage is defined in
42 U.S.C.
413(d) (as in effect
October 1, 2019), and is published annually in the
Federal Register.
(11) "Veteran"
means a person who served in the active United States
military, naval, or air service, who fulfilled the minimum active duty service
requirements and was released with a discharge characterized as honorable and
not on account of alienage, including veterans who die while serving in active
duty in the armed forces of the United States as defined in
38
U.S.C. 1101 (as in effect October 1, 2019). A
veteran also includes individuals with certain military service before July 1,
1946 in the military forces (including certain organized guerilla forces) of
the government of the Commonwealth of the Philippines and certain service in
the Philippine scouts as described in
38 U.S.C.
107 (as in effect October 1,
2019).
(12) "Victim of
trafficking" refers to:
(a)
A
victim of trafficking and certain family members, as
identified in the Trafficking Victims Protection Reauthorization Act of 2003
(TVPRA) (Pub.
L. No. 108-193), who are eligible for federally
funded or administered benefits to the same extent as refugees, per
22 U.S.C.
7105(b)(1)(A) (as in effect
October 1, 2019).
(b)
Avictim of
trafficking who is awarded a certification letter from the office of
refugee resettlement (ORR) and is potentially eligible for medical assistance.
Certain family members of a
victim
of trafficking are awarded "Derivative T" visas and are potentially eligible
for medical assistance.
(i)
The ORR makes the certification
determination and issues a
letter of certification for an
adult
victim of trafficking.
(ii)
A
victim
of trafficking who is younger than eighteen years of age
does not
need to be certified in order to receive benefits. Instead,
the ORR issues a
notarized letter similar to an
adult certification letter,
stating the child is a victim of trafficking.
(c) A victim of trafficking is not required
to provide any other documentation of immigration status to receive
medical
assistance, unless the victim's immigration status has changed.
(C) An individual who is not a U.S. citizen or national must be in a satisfactory immigration status to be eligible for medical assistance. An individual is considered to be in satisfactory immigration status if the individual is:
(1) A non-citizen who was lawfully residing
in the United States as of August 22, 1996, and continues to be a lawful
resident of the U.S.
(2) An
indefinite detainee only if the individual was in a satisfactory immigration
status when the individual became an indefinite detainee.
(3) A non-citizen who was granted qualified
non-citizen status on or after August 22, 1996,
does not have a satisfactory immigration status for medical assistance for a
period of five years beginning on the date the status was granted, unless the
individual is one of the following:
(a) An
individual whose immigration status meets any of the following criteria:
(i) Refugee; or
(ii)
Asylee; or
(iii)
A person whose deportation is being
withheld under section 243(h) of the INA (as in effect October
1, 2019); or
(iv) Cuban or Haitian entrant;
or
(v) Amerasian immigrant;
or
(vi) Victim of trafficking; or
(vii) Afghan or Iraqi special
immigrant.
(b) A
lawfully residing pregnant woman.
(c) A lawfully residing child.
(d) An LPR who has forty quarters of coverage
under Title II of the Social Security Act (as in effect
October 1, 2019) or can be credited with such
quarters.
(i) In determining the number of
quarters of coverage, an LPR shall be credited as follows:
(a)
All qualifying
quarters worked by the LPR; and
(b) All of the
qualifying quarters of coverage worked by a natural or adoptive parent of
the
LPR before the date the individual attains age eighteen can be credited;
and
(c) All of the
qualifying quarters worked by a spouse of the LPR during their marriage shall
be credited so long as the
LPR remains married to such spouse or such spouse
is deceased; and
(d) A parent or spouse
whose quarters are credited to the LPR must be a
U.S. citizen or an LPR.
(ii) A qualifying quarter does not include
any quarter after December 31, 1996, in which the LPR also
received a federal means-tested public benefit.
(e) An individual who:
(i) Is a military member on active duty
(other than active duty for training) in the armed forces of the United States;
or
(ii) Is a veteran who received
an honorable discharge, not a discharge on account of alienage as described in
8
U.S.C. 1426 (as in effect
October 1, 2019).
(f) A spouse or unmarried dependent child of
a veteran or active duty service member as described in paragraph (C)(3)(e) of this
rule.
(g) The surviving spouse of a
deceased veteran or service member, provided the spouse has not remarried and
the marriage fulfills the following requirements:
(i) Married for at least one year;
or
(ii) Married before the end of a
fifteen-year time span following the end of the period of military service in
which the injury or disease was incurred or aggravated; or
(iii) Married for any period if a child was
born of or before the marriage.
(h) An American Indian born in Canada
with at least fifty per cent American Indian blood,
covered by the provisions of 289 of the INA (8 U.S.C.
1359)
(as in effect
October 1, 2019).
(i) A member of
an Indian tribe, as defined in
25
U.S.C. 450b(e)
(as in
effect October 1, 2019)and the Indian
Self-Determination and Education Assistance Act of 1975 ( Pub. L. No. 93-638
).
(D) An individual who is not a U.S. citizen or national and not in a satisfactory immigration status may be eligible for alien emergency medical assistance as described in rule 5160:1-5-06 of the Administrative Code, and is not required to verify non-citizenship status.
(E) Any individual applying for medical assistance and declaring a satisfactory immigration status shall bear the burden of proof of satisfactory immigration status.
(F) The process for establishing satisfactory immigration status shall include that:
(1) The
administrative agency must attempt to verify an individual's immigrant status
through the electronic eligibility system.
(2) If the individual's immigrant status
cannot be verified through the electronic eligibility system, the individual
must present documentary evidence of immigration status. The administrative
agency is required to confirm the authenticity of the documentation provided by
the individual through the automated systematic alien verification for
entitlements (SAVE) system. Documentary evidence of immigration status refers
to:
(a) I-94 (arrival/departure
record).
(b) I-551 (permanent
resident card).
(c) Visa in
passport with a stamp from the appropriate issuing agency showing immigration
status.
(d) For
a
victim of trafficking:
(i) The original certification letter or
notarized letter from the
ORR for a child
is to be used in place of immigration documentation from USCIS. Retain a copy
in the case file. A victim of
trafficking is not required to provide any other immigration
documents to receive benefits.
(ii)
The SAVE system does not contain information about victims of
trafficking.
(e) Other
documentation as prescribed or allowed by federal law.
(f) An indefinite detainee
may not have documentation of original immigration
status, and should instead present the following documentation, available from
the ORR:
(i)
I-220B (order of supervision), which must include the
person's
A-number and notation concerning exclusion, deportation, or removal; or
(ii) I-766 (employment authorization
document) which must show
8 U.S.C.
1231(a)(7) (as in effect
October 1, 2019) as the provision of law authorizing
employment.
(3) When the individual's eligibility is
based upon the veteran status of the individual, the individual's parent, or
the individual's spouse, veteran status is verified by viewing an original or
certified copy of the
veteran's discharge paper, United States department of
defense form DD-214 (undated).
(G) If the administrative agency has been unable to verify satisfactory immigration status through the electronic eligibility system, and the individual has not provided verification as described in paragraph (F)(2) of this rule, the administrative agency:
(1)
Is
to provide a reasonable opportunity period in accordance with paragraph (H) of
this rule; and
(2)
Is not to delay, deny, reduce, or discontinue benefits
for an individual who is determined by the agency to be otherwise eligible for
medical assistance during such reasonable opportunity period, in accordance
with
42 C.F.R.
435.911(c) (as in effect
October 1, 2019).
(3)
Is to promptly provide the individual with information
obtained from the electronic data source described in paragraph (F) of this
rule so that he or she can attempt to resolve any inconsistencies with regard
to immigration status.
(H) The reasonable opportunity period:
(1)
Begins on and
extends up to ninety days from the date the notice of reasonable opportunity is
received by the individual.
(a)
The date on which the notice is received is considered
to be five days after the date on the notice, unless the individual shows that
he or she did not receive the notice within the five-day
period.
(b)
The reasonable opportunity period may end before the
ninetieth day if the agency verifies the individual's satisfactory immigration
status.
(c)
Medical assistance coverage for an individual on a
reasonable opportunity period is effective the first day of the calendar month
in which the Ohio department of medicaid (ODM) receives the application as
defined in rule
5160:1-2-01
of the Administrative Code.
(2)
May be extended.
The administrative agency is to provide an extension of the reasonable
opportunity period if the individual is making a good faith effort to resolve
any inconsistencies or obtain necessary documentation or if the administrative
agency is unable to complete the verification process within the ninety-day
reasonable opportunity period.
(3)
Is granted with
each application needing verification of satisfactory immigration status,
provided the individual satisfies all other conditions of eligibility outlined
in rule
5160:1-2-10
of the Administrative Code. If an individual who was previously provided a
reasonable opportunity period was discontinued after ninety days for failing to
provide verification, he or she is to be granted another ninety-day reasonable
opportunity period with each subsequent new application.
(4)
Ends on:
(a)
The date the
administrative agency verifies the individual's satisfactory immigration
status; or
(b)
The last day of the month in which the ninetieth day
falls as described in paragraph (H)(1) of this rule; or
(c)
An administrative
agency approved extension date beyond the ninety-day reasonable opportunity
period when:
(i)
The administrative agency has determined the individual
is making a good faith effort to resolve any inconsistencies or obtain
necessary documentation; or
(ii)
The
administrative agency is unable to complete the verification process within the
ninety-day reasonable opportunity period.
(5)
Retroactive coverage.
(a)
There is no
provision for retroactive coverage for individuals on a reasonable opportunity
period.
(b)
If an individual provides evidence of satisfactory
immigration status during his or her ninety-day reasonable opportunity period,
he or she may have eligibility explored for retroactive medical assistance in
accordance with 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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