Ohio Admin. Code 5160:1-1-04 - Medicaid: income and eligibility verification system (IEVS)

(A) This rule describes the requirements in section 1137 of the Social Security Act (as in effect October 1, 2020) and in section 42 C.F.R. 435.945 (as in effect October 1, 2020), requiring state agencies administering certain federally funded public assistance programs to establish procedures for obtaining, using, and verifying information relevant to determinations of eligibility. The Ohio department of medicaid (ODM) shall obtain and share income and benefit information with the following sources:
(1) The social security administration (SSA).
(2) The internal revenue service (IRS).
(3) The state wage information collection agency (SWICA).
(4) Agencies administering unemployment compensation (UC) benefits.
(B) Definition. "Income and eligibility verification system" (IEVS) is defined in rule 5160:1-1-01 of the Administrative Code.
(C) Administrative agency responsibilities. Within forty-five days of receipt of the information, the administrative agency shall initiate, pursue, and complete the actions specified in this paragraph:
(1) Provide adequate safeguards in accordance with rule 5160-1-32 of the Administrative Code.
(2) Inform all individuals in writing at the time of application and renewal that the agency will obtain and use information available from IEVS data matches to verify initial or ongoing eligibility for medicaid.
(3) Review and compare against the case record all information received from the IEVS data matches to determine whether the information affects the individual's eligibility, in accordance with 42 C.F.R. 435.948 (as in effect October 1, 2020).
(4) Obtain additional information or documentation from the individual, if needed, to determine eligibility and initiate appropriate action in accordance with 42 C.F.R. 435.952(c) (as in effect October 1, 2020).
(5) Continue benefits while the steps listed in this rule are being taken to verify the matched data in accordance with 42 C.F.R. 435.952(d) (as in effect October 1, 2020). The administrative agency shall verify information relating to:
(a) The amount of the income and resource involved; and
(b) Whether the individual actually has or had access and use of the resource, income, or both; and
(c) The period of time during which the individual actually has or had access to the resource, income, or both.
(6) Update case information and redetermine eligibility when the verification received is discrepant from the information currently listed in the electronic eligibility system. The discrepancy threshold is determined by ODM.

Replaces: 5160:1-1-04


Ohio Admin. Code 5160:1-1-04
Effective: 6/1/2021
Five Year Review (FYR) Dates: 06/01/2026
Promulgated Under: 111.15
Statutory Authority: 5160.02, 5163.02
Rule Amplifies: 5160.02, 5163.02
Prior Effective Dates: 01/01/1983, 12/01/1986, 03/13/1987 (Emer.), 05/04/1987, 09/01/1989 (Emer.), 11/30/1989, 01/01/1990 (Emer.), 04/01/1990, 01/01/1993, 09/01/1994, 11/01/1996, 07/01/1998, 07/01/1999, 10/01/2002, 10/06/2003, 11/01/2009, 01/10/2015

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