Ohio Admin. Code 5160:1-3-02.3 - Medicaid: coverage for individuals receiving supplemental security income (SSI) benefits
(A) This rule describes eligibility for
medical assistance for aged, blind, or disabled
individuals who receive SSI benefits authorized by the social security
administration under Title XVI of the Social Security Act (as in effect
on October 1, 2017
2023).
Eligibility for this category shall be determined
for applications for medical assistance filed on or after August 1,
2016.
(B) Eligibility
criteria. To be eligible for coverage under this group an individual must be
receiving SSI benefits based on the social security administration's
determination of eligibility for SSI payments. In addition, certain
requirements specific to medical assistance must be met in order for an
individual to be eligible under this group. Failure to comply with the
following requirements will prevent an individual from being determined
eligible under this provision:
(1) Consistent
with rule
5160:1-2-10 of the
Administrative Code:
(a) An individual must
assign to the state of Ohio any rights to medical support and payments for
medical care from any third party; and
(b) An individual must cooperate with the
child support enforcement agency (CSEA) in establishing the paternity of any
child eligible for medical assistance and in obtaining medical support and
payments for medical care from any third party, in accordance with
42 C.F.R.
433.147 (as in effect
on October 1, 2017
2023);
and
(c) An individual must
cooperate with the administrative agency in identifying and providing
information to assist the state with pursuing any third party who may be liable
to pay for care and services; and
.
(2) An individual who is the beneficiary of a
trust must provide documentation of the trust as required by rule
5160:1-3-05.2 of the
Administrative Code.
(C)
Retroactive coverage is available for this program in accordance with rule
5160:1-2-01 of the
Administrative Code, but coverage under this rule
shall not begin prior to August 1, 2016, and shall not provide reimbursement of
services rendered prior to August 1, 2016.
Notes
Promulgated Under: 111.15
Statutory Authority: 5160.02, 5163.02
Rule Amplifies: 5160.02, 5163.02
Prior Effective Dates: 08/01/2016, 04/01/2018
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