Ohio Administrative Code
Title 5160:1 - Eligibility
Chapter 5160:1-4 - Medicaid for the MAGI Covered Groups
Section 5160:1-4-05 - MAGI-based medicaid: coverage for a parent or caretaker relative residing with a child
Universal Citation: OH Admin Code 5160:1-4-05
Current through all regulations passed and filed through September 16, 2024
(A) This rule describes the eligibility requirements for parents and caretaker relatives residing with children as described in 42 C.F.R. 435.110 (as in effect October 1, 2023), transitional medical assistance as described in section 1925 of the Social Security Act (as in effect October 1, 2023), and extended medical assistance as described in section 1931 of the Social Security Act (as in effect October 1, 2023).
(B) Eligibility criteria for coverage because an individual is a parent or caretaker relative residing with a child.
(1)
The individual must be residing with a dependent child under the age of
eighteen. An individual is considered to be residing with the child even if the
child is temporarily absent with the intent to return home.
(2) The individual must be the child's parent
or caretaker relative, or a spouse residing with the child's parent or
caretaker relative.
(3) The
individual's household income must not exceed ninety per cent of the federal
poverty level for the family size.
(C) Eligibility criteria for coverage under transitional medical assistance (TMA) or extended medical assistance (EMA).
(1) To be eligible for TMA or EMA an
individual must have:
(a) Been
enrolled in medical
assistance coverage as a parent or caretaker relative as described in paragraph
(B) of this rule for at least three of the six months immediately preceding the
loss of eligibility.
(b) Become
ineligible for medical assistance as a parent or caretaker relative as a result
of:
(i) Increased earned income, to be
eligible for the first six-month period of TMA. Verification of increased
income is not required and can be self-declared.
(ii) Increased collection of spousal support,
to be eligible for EMA. Verification of increased income is not required and
can be self-declared.
(2) Duration of eligibility.
(a) A parent or caretaker relative is
eligible for:
(i) Up to two six-month periods
of TMA.
(a) The first six-month period of TMA
beginning the first day of the month following the expiration of the
required notice period under rule
5101:6-2-04 of the
Administrative Code for discontinuance of coverage as a parent or
caretaker relative.
(b) The second
six-month period of TMA beginning the month immediately following the
completion of the first six-month period when the parent or caretaker relative
:
(i)
Received
continuous TMA for the entire first six-month period; and
(ii)
Met the
quarterly request for financial information requirements for the first
six-month period described in paragraph (D) of this rule; and
(iii)
Has average
gross monthly earned income minus employment-related child care expenses (if
applicable) that does not exceed one hundred eighty-five per cent of the
federal poverty level for the family size.
(ii) Four months of EMA beginning
the first day of the month following the expiration of the
required notice period under rule
5101:6-2-04 of the
Administrative Code for discontinuance of coverage as a parent or
caretaker relative.
(b) The child of the parent or caretaker
relative will remain eligible for medical assistance regardless of the parent
or caretaker relative's increased earned income or spousal support for a
continuous period of twelve months under rule
5160:1-2-14 of the
Administrative Code. At the
end of that twelve-month period, the child becomes eligible for any remaining
months of TMA or EMA for which the parent or caretaker relative is eligible,
ending in the same month as TMA or EMA ends for the parent or caretaker
relative.
(c)
The child of the parent or caretaker relative eligible
under this rule loses TMA or EMA eligibility at the end of the month in which
he or she reaches age nineteen.
(3) Resuming interrupted spans of TMA
eligibility.
(a) An individual whose span of
TMA was interrupted because the individual became eligible for coverage under
paragraph (B) of this rule is eligible for a new span of TMA
when the
individual subsequently loses eligibility under paragraph (B) of this rule due
to an increase in earned income and meets the
criteria in paragraph (C)(1)(a) of this rule.
(b) An individual whose span of TMA was
interrupted because the individual became eligible for coverage under paragraph
(B) of this rule is eligible for any remaining months of the original TMA span
when the
individual subsequently loses eligibility under paragraph (B) of this rule due
to an increase in earned income and does not meet the criteria in paragraph
(C)(1)(a) of this rule.
(4) Repeated spans of eligibility. There is
no limit to the number of times an individual may receive coverage under TMA or
EMA, provided the individual meets all of the relevant criteria for the
coverage each time.
(D) Quarterly request for financial information for TMA. The parent or caretaker relative must report his or her gross earned income and employment-related child care expenses (if applicable) quarterly to the administrative agency by the fifth business day of the fourth, seventh, and tenth months of TMA coverage.
(E) Administrative agency responsibilities. The administrative agency must:
(1) Calculate a parent's or caretaker
relative's family size and household income as described in rule
5160:1-4-01 of the
Administrative Code for parent or caretaker relative eligibility.
(2)
Send a quarterly
request for financial information to the parent or caretaker relative no later
than the third week of the third, sixth, and ninth months of TMA
coverage.
(3)
Update the electronic eligibility system with
information reported from the quarterly request for financial
information.
(4) Determine
eligibility for the second six-month period of TMA.
(5) Consider an
individual's eligibility for TMA or EMA as part of the renewal
process described in rule
5160:1-2-01 of the
Administrative Code and the pre-termination review
(PTR) process described in rule
5160:1-1-01 of the
Administrative Code.
(a) Verify in the
electronic eligibility system the individual was receiving medical assistance
in previous months. Approve TMA or EMA when an individual
meets the requirements in paragraph (C) of this rule;
(b) Deny or
discontinue TMA or EMA when :
(i)
There is no longer a dependent child under the age of
eighteen residing with the parent or caretaker relative; or
(ii)
The parent or
caretaker relative:
(a)
Become eligible for another medical assistance covered
group; or
(b)
No longer has earned income for TMA; or
(c)
No longer
collects spousal support for EMA; or
(d)
Fails to report
gross earned income and employment-related child care expenses (if applicable)
quarterly for TMA; or
(e)
Is over income for the second six-month period of TMA;
or
(f)
Receives four months of EMA; or
(g)
Receives twelve
months of TMA.
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