Ohio · statute · Ohio Rev. Code ch. 5163 · 33 active provisions
As used in this chapter:"Caretaker relative" has the same meaning as in 42 C.F.R. 435.4 as that regulation is amended effective January 1, 2014."Expansion eligibility group" means the medicaid eligibility group described in section 1902(a)(10)(A)(i)(VIII) of the "Social Security Act," 42 U.S.C. 1396a(a)(10)(A)(i)(VIII)…
The medicaid director shall adopt rules as necessary to implement this chapter. The rules shall establish eligibility requirements for the medicaid program. The rules may establish requirements for applying for medicaid and determining and verifying eligibility for medicaid. The rules shall be adopted in accordance wit…
(A) The medicaid program shall cover all mandatory eligibility groups. (B) The medicaid program shall cover all of the optional eligibility groups that state statutes require the medicaid program to cover. (C) The medicaid program may cover any of the optional eligibility groups to which either of the following applies…
(A) If the federal medical assistance percentage for medical assistance provided to members of the expansion eligibility group is set below ninety per cent, the department of medicaid shall do both of the following: (1) Immediately discontinue all medical assistance for members of the group. (2) Not later than fifteen…
The medicaid program's eligibility requirements for aged, blind, and disabled individuals may be more restrictive than the eligibility requirements for the supplemental security income program. Any such more restrictive eligibility requirements shall be consistent with the 209(b) option described in the "Social Securit…
The medicaid program shall cover all of the following optional eligibility groups: (A) The group consisting of children placed with adoptive parents who are specified in section 1902(a)(10)(A)(ii)(VIII) of the "Social Security Act," 42 U.S.C. 1396a(a)(10)(A)(ii)(VIII); (B) Subject to section 5163.061 of the Revised Cod…
The income eligibility threshold is two hundred per cent of the federal poverty line for women during pregnancy and the postpartum period beginning on the last day of the pregnancy who are covered by the medicaid program under division (B) of section 5163.06 of the Revised Code. Last updated August 16, 2021 at 3:36 PM
The medicaid director shall adopt rules under section 5163.02 of the Revised Code as necessary to provide medicaid coverage for the optional eligibility group described in section 1902(a)(10)(A)(ii)(XIII) of the "Social Security Act," 42 U.S.C. 1396a(a)(10)(A)(ii)(XIII). By requiring the medicaid program to provide cov…
The medicaid director shall implement the option authorized by the "Social Security Act," section 1931(b)(2)(C), 42 U.S.C. 1396u-1(b)(2)(C), to set the income eligibility threshold at ninety per cent of the federal poverty line for parents and caretaker relatives who are covered by the medicaid program under that secti…
(A) As used in sections 5163.09 to 5163.098 of the Revised Code: "Applicant" means an individual who applies to participate in the medicaid buy-in for workers with disabilities program."Earned income" has the meaning established by rules authorized by section 5163.098 of the Revised Code."Employed individual with a med…
Under the medicaid buy-in for workers with disabilities program, an individual who does both of the following in accordance with rules authorized by section 5163.098 of the Revised Code qualifies for the medicaid program: (A) Applies for the medicaid buy-in for workers with disabilities program; (B) Provides satisfacto…
(A) Except as provided in division (B) of this section, the maximum value of resources, less amounts disregarded pursuant to rules authorized by section 5163.098 of the Revised Code, that an individual may have without the individual exceeding the resource eligibility limit for the medicaid buy-in for workers with disa…
For the purpose of determining whether an individual is within the income eligibility limit for the medicaid buy-in for workers with disabilities program, all of the following apply: (A) Twenty thousand dollars of the individual's earned income shall be disregarded. (B) No amount that the individual's employer pays to…
An individual shall not be required to pay a premium as a condition of qualifying for the medicaid buy-in for workers with disabilities program. Last updated August 13, 2025 at 10:21 AM
No individual shall be denied eligibility for the medicaid buy-in for workers with disabilities program on the basis that the individual receives services under a home and community-based services medicaid waiver component.
An individual participating in the medicaid buy-in for workers with disabilities program may continue to participate in the program for up to six months even though the individual ceases to have earnings from employment or to be an employed individual with a medically improved disability due to ceasing to be employed i…
If the United States secretary of health and human services requires that a provision of the medicaid buy-in for workers with disabilities program be changed or removed in order for the secretary to approve the program or to avoid an extended delay in the secretary's approval, the medicaid director shall make the chang…
(A) The medicaid director shall adopt rules under section 5163.02 of the Revised Code as necessary to implement the medicaid buy-in for workers with disabilities program. The rules shall do all of the following: (1) Specify assets, asset values, and amounts to be disregarded in determining asset and income eligibility…
(A) As used in this section: ( 1) "Presumptive eligibility for pregnant women option" means the option available under section 1920 of the "Social Security Act," 42 U.S.C. 1396r-1, to make ambulatory prenatal care available to pregnant women under the medicaid program during presumptive eligibility periods. ( 2) "Quali…
(A) As used in this section: (1) "Children's hospital" has the same meaning as in section 2151.86 of the Revised Code. (2) "Federally qualified health center" has the same meaning as in section 1905(l)(2)(B) of the "Social Security Act," 42 U.S.C. 1396d(l)(2)(B). (3) "Federally qualified health center look-alike" has t…
(A) As used in this section: (1) "Presumptive eligibility error rate" means the rate at which a qualified entity or qualified provider deems an individual presumptively eligible for medicaid under sections 5163.10 to 5163.102 of the Revised Code when the individual is ineligible for the medicaid program. (2) "Qualified…
As used in this section, "presumptive eligibility error rate" has the same meaning as in section 5163.103 of the Revised Code. Quarterly, the department of medicaid shall report to the general assembly the presumptive eligibility error rate for presumptive eligibility determinations made during the previous quarter. Re…
To the extent permissible under federal law, the department of medicaid shall redetermine the eligibility of members of the expansion eligibility group for medicaid benefits every six months. Last updated August 26, 2025 at 5:42 PM
If a medicaid recipient is the beneficiary of a trust created pursuant to section 5815.28 of the Revised Code, then, notwithstanding any contrary provision of this chapter or of a rule adopted under section 5163.02 of the Revised Code, divisions (C) and (D) of that section shall apply in determining the assets or resou…
(A)(1) This section applies only to either of the following: (a) Initial eligibility determinations for the medicaid program; (b) An appeal from an initial eligibility determination pursuant to section 5160.31 of the Revised Code. (2)(a) Except as provided in division (A)(2)(b) of this section, this section shall not b…