2006 Ohio Revised Code - 5111.01. Eligibility for medical program; rules establishing standards, procedures and other requirements.

§ 5111.01. Eligibility for medical program; rules establishing standards, procedures and other requirements.
 

As used in this chapter, "medical assistance program" or "medicaid" means the program that is authorized by this chapter and provided by the department of job and family services under this chapter, Title XIX of the "Social Security Act," 79 Stat. 286 (1965), 42 U.S.C.A. 1396, as amended, and the waivers of Title XIX requirements granted to the department by the health care financing administration of the United States department of health and human services. 
 

The department of job and family services shall act as the single state agency to supervise the administration of the medicaid program. As the single state agency, the department shall comply with 42 C.F.R. 431.10(e). The department's rules governing medicaid are binding on other agencies that administer components of the medicaid program. No agency may establish, by rule or otherwise, a policy governing medicaid that is inconsistent with a medicaid policy established, in rule or otherwise, by the director of job and family services. 

(A) The department of job and family services may provide medical assistance under the medicaid program as long as federal funds are provided for such assistance, to the following: 

(1) Families with children that meet either of the following conditions: 

(a) The family meets the income, resource, and family composition requirements in effect on July 16, 1996, for the former aid to dependent children program as those requirements were established by Chapter 5107. of the Revised Code, federal waivers granted pursuant to requests made under former section 5101.09 of the Revised Code, and rules adopted by the department or any changes the department makes to those requirements in accordance with paragraph (a)(2) of section 114 of the "Personal Responsibility and Work Opportunity Reconciliation Act of 1996," 110 Stat. 2177, 42 U.S.C.A. 1396u-1, for the purpose of implementing section 5111.019 [5111.01.9] of the Revised Code. An adult loses eligibility for medical assistance under division (A)(1)(a) of this section pursuant to division (E) of section 5107.16 of the Revised Code. 

(b) The family does not meet the requirements specified in division (A)(1)(a) of this section but is eligible for medical assistance pursuant to section 5101.18 of the Revised Code. 

(2) Aged, blind, and disabled persons who meet the following conditions: 

(a) Receive federal aid under Title XVI of the "Social Security Act," or are eligible for but are not receiving such aid, provided that the income from all other sources for individuals with independent living arrangements shall not exceed one hundred seventy-five dollars per month. The income standards hereby established shall be adjusted annually at the rate that is used by the United States department of health and human services to adjust the amounts payable under Title XVI. 

(b) Do not receive aid under Title XVI, but meet any of the following criteria: 

(i) Would be eligible to receive such aid, except that their income, other than that excluded from consideration as income under Title XVI, exceeds the maximum under division (A)(2)(a) of this section, and incurred expenses for medical care, as determined under federal regulations applicable to section 209(b) of the "Social Security Amendments of 1972," 86 Stat. 1381, 42 U.S.C.A. 1396a(f), as amended, equal or exceed the amount by which their income exceeds the maximum under division (A)(2)(a) of this section; 

(ii) Received aid for the aged, aid to the blind, or aid for the permanently and totally disabled prior to January 1, 1974, and continue to meet all the same eligibility requirements; 

(iii) Are eligible for medical assistance pursuant to section 5101.18 of the Revised Code. 

(3) Persons to whom federal law requires, as a condition of state participation in the medicaid program, that medical assistance be provided; 

(4) Persons under age twenty-one who meet the income requirements for the Ohio works first program established under Chapter 5107. of the Revised Code but do not meet other eligibility requirements for the program. The director shall adopt rules in accordance with Chapter 119. of the Revised Code specifying which Ohio works first requirements shall be waived for the purpose of providing medicaid eligibility under division (A)(4) of this section. 

(B) If funds are appropriated for such purpose by the general assembly, the department may provide medical assistance to persons in groups designated by federal law as groups to which a state, at its option, may provide medical assistance under the medicaid program. 

(C) The department may expand eligibility for medical assistance to include individuals under age nineteen with family incomes at or below one hundred fifty per cent of the federal poverty guidelines, except that the eligibility expansion shall not occur unless the department receives the approval of the federal government. The department may implement the eligibility expansion authorized under this division on any date selected by the department, but not sooner than January 1, 1998. 

(D) In addition to any other authority or requirement to adopt rules under this chapter, the director may adopt rules in accordance with section 111.15 of the Revised Code as the director considers necessary to establish standards, procedures, and other requirements regarding the provision of medical assistance. The rules may establish requirements to be followed in applying for medical assistance, making determinations of eligibility for medical assistance, and verifying eligibility for medical assistance. The rules may include special conditions as the department determines appropriate for making applications, determining eligibility, and verifying eligibility for any medical assistance that the department may provide pursuant to division (C) of this section and section 5111.014 [5111.01.4] or 5111.019 [5111.01.9] of the Revised Code. 
 

HISTORY: 143 v H 672 (Eff 11-14-89); 143 v H 822 (Eff 12-13-90); 144 v H 298 (Eff 7-26-91); 144 v H 478 (Eff 1-14-93); 146 v H 167 (Eff 11-15-95); 146 v H 710 (Eff 6-11-96); 147 v H 215 (Eff 6-3-97); 147 v H 408 (Eff 10-1-97); 148 v H 283 (Eff 9-29-99); 148 v H 471 (Eff 7-1-2000); 149 v H 94. Eff 9-5-2001.
 

Not analogous to former RC § 5111.01 (GC § 6289-1; 119 v 384; Bureau of Code Revision, 10-1-53), repealed 128 v 645, § 2, eff 9-7-59.

The effective date is set by section 204 of HB 94. 

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