Ohio Admin. Code 5101:2-46-11 - Title XIX medicaid coverage for Title IV-E kinship guardianship assistance program (KGAP) eligible children
(A)
A child eligible
for KGAP, is eligible for Title XIX medicaid coverage beginning with the
effective date of the JFS 00133 "Title IV-E Kinship Guardianship Assistance
Program (KGAP) Agreement."
(B)
Ohio department
of job and family services (ODJFS) is to inform the kinship caregiver(s) that
they are to notify ODJFS within fifteen calendar days after moving to another
county or state.
(C)
The kinship caregiver(s) is to cooperate with ODJFS to
assure that a move out-of-state complies with any applicable interstate
requirements pursuant to rule
5101:2-44-05.2 of the
Administrative Code. Failure to notify ODJFS may result in the interruption of
Title XIX medical coverage.
(D)
For a child with
a KGAP agreement in effect who moves or resides out-of-state, the following is
to apply:
(1)
After seven business days after ODJFS is notified by the
kinship caregiver(s) that the KGAP eligible child is moving to or residing in
another state, ODJFS is to transfer Title XIX medical coverage to the state of
residence by:
(a)
Completing and forwarding the current signed and dated
JFS 00133 to the Ohio department of job and family services (ODJFS) interstate
compact and medical assistance (ICAMA) state administrator pursuant to rule
5101:2-44-05.2 of the
Administrative Code.
(b)
Providing notification to the kinship caregiver(s) of
Ohio's intent to terminate the Title XIX medical coverage. Notification is to,
at a minimum, include all of the following:
(i)
The effective
termination date of Ohio's Title XIX medical coverage.
(ii)
A completed JFS
04065 "Prior Notice of Right To A State Hearing."
(iii)
A statement
that the child will continue to receive KGAP payments from Ohio or, if no
payments are being made, a statement that the JFS 00133 "Title IV-E Kinship
Guardianship Assistance Program (KGAP) Agreement" remains in effect and Title
XIX medical coverage will be provided by the state in which the child
resides.
(c)
Terminating the medical coverage in the Ohio statewide
automated child welfare information system (SACWIS).
(2)
Upon notification
of any change that would affect the medicaid status, ODJFS is to, complete and
forward the ICAMA form 7.5 "Information Exchange" which can be found at:
https://aaicama.org/cms/index.php/the-aaicama/new-icama-forms/icama-forms
to ODJFS ICAMA state administrator.
(3)
ODJFS is to
provide the responsible Title XIX medical authority in the state where the
child resides with verification that the child meets the continuing eligibility
requirements for medicaid. If ODJFS determines the child does not meet the
continuing eligibility requirements, within twenty business days ODJFS is
to:
(a)
Complete
a medicaid pre-termination review (PTR) of continuing medicaid eligibility
pursuant to rule
5160:1-2-01 of the
Administrative Code.
(b)
Provide notification of the date Title XIX medical
coverage is to be terminated to the responsible Title XIX medical authority in
the state in which the KGAP eligible child resides.
(E)
For a
child with an out-of-state KGAP agreement in effect who moves to or resides in
Ohio, the following is to apply:
(1)
The child is automatically eligible for Title XIX
medical coverage provided by Ohio.
(2)
ODJFS ICAMA
administrator is to take the following actions to activate Title XIX medical
coverage:
(a)
Verify the following information is included on the ICAMA
form 7.01 received from the
responsible Title XIX authority and the national ICAMA database:
(i)
The child's name,
social security number, date of birth, and address.
(ii)
The name of
kinship caregiver(s).
(iii)
The address where the medical card should be
sent.
(iv)
A copy of the sending state's KGAP
agreement.
(v)
The name, address, and telephone number of a contact
person in the state with KGAP case management responsibility.
(vi)
The termination
date of Title XIX medical coverage in the state with KGAP case management
responsibility or the state where the child moved.
(vii)
Any additional
information regarding other health insurance coverage the child may have,
including third-party liability.
(b)
Enter into Ohio
SACWIS the Ohio medicaid effective date and an "active" status on the ICAMA
record.
(c)
Complete the ODM 06612 "Health Insurance Information
Sheet" if there is information that the child is covered by a private health
insurance plan.
(3)
ODJFS is to
maintain a separate case record for each KGAP eligible child who resides in
Ohio. The case record is to contain all of the information required in
paragraph (D) of this rule for all children with KGAP agreements in effect who
move to or reside in Ohio.
Notes
Promulgated Under: 119.03
Statutory Authority: 5153.163, 5101.1417
Rule Amplifies: 5153.163, 5153.16
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