(A) This rule describes the eligibility
requirements for parents and caretaker relatives residing with children as
described in
42 C.F.R.
435.110 (as in effect
on October 1,
2017
2019),
transitional medical assistance as described in section 1925 of the Social
Security Act (as in effect
on October 1,
2017
2019)
, and extended medical assistance as described in
section 1931 of the Social Security Act (as in effect
on October 1,
2017
2019).
(B) Eligibility criteria for coverage because
an individual is a parent or caretaker relative residing with a child.
(1) The individual must be residing with a
dependent child under the age of eighteen. An individual is considered to be
residing with the child even if the child is temporarily absent with the intent
to return home.
(2) The individual
must be the child's parent or caretaker relative, or a spouse residing with the
child's parent or caretaker relative.
(3) The individual's household income must
not exceed ninety per cent of the federal poverty level for the family
size.
(C) Eligibility
criteria for coverage under transitional medical assistance (TMA) or extended
medical assistance (EMA).
(1) To be eligible
for TMA or EMA an individual must have:
(a)
Been eligible for and enrolled in medical assistance coverage as a parent or
caretaker relative as described in paragraph (B) of this rule for at least
three of the six months immediately preceding the loss of
eligibility.
(b) Become ineligible
for medical assistance as a parent or caretaker relative as a result of:
(i) Increased earned income, to be eligible
for the first six-month period of TMA. Verification of increased income is not
required and can be self-declared.
(ii) Increased collection of spousal support,
to be eligible for EMA. Verification of increased income is not required and
can be self-declared.
(2) Duration of eligibility.
(a) A parent or caretaker relative is
eligible for:
(i) Up to two six-month periods
of TMA.
(a) The first six-month period of TMA
beginning the month immediately following the last month the individual had
income below the threshold for coverage as a parent or caretaker relative. Any
months of medical assistance received in error due to unreported income are
counted as months of TMA.
(b) The
second six-month period of TMA beginning the month immediately following the
completion of the first six-month period when the parent or caretaker relative
received continuous TMA for the entire first six-month
period.
:
(i)
Received continuous TMA for the
entire first six-month period; and
(ii)
Met the quarterly request for
financial information requirements for the first six-month period described in
paragraph (D) of this rule; and
(iii)
Has average gross monthly earned
income minus employment-related child care expenses (if applicable) that does
not exceed one hundred eighty-five per cent of the federal poverty level for
the family size.
(ii) Four months of EMA beginning the month
immediately following the last month the individual had income below the
threshold for coverage as a parent or caretaker relative. Any months of medical
assistance received in error due to unreported collection of spousal support
are counted as months of EMA.
(b) The child of the parent or caretaker
relative will remain eligible for medical assistance regardless of the parent
or caretaker relative's increased earned income or spousal support for a
continuous period of twelve months under rule
5160:1-2-14
of the Administrative Code. The twelve month period begins on the date
eligibility for medical assistance was approved. At the end of that
twelve-month period, the child becomes eligible for any remaining months of TMA
or EMA for which the parent or caretaker relative is eligible, ending in the
same month as TMA or EMA ends for the parent or caretaker relative.
(c) The child of the parent or
caretaker relative eligible under this rule loses TMA or EMA eligibility at the
end of the month in which he or she reaches age nineteen.
(3) Resuming
interrupted spans of TMA eligibility.
(a)
Individuals
An
individual whose span of TMA was interrupted because the individual
became eligible for coverage under paragraph (B) of this rule is eligible for a
new span of TMA if the individual subsequently loses eligibility under
paragraph (B) of this rule due to increase in earned income and meets the
criteria in paragraph (C)(1)(a) of this rule.
(b)
Individuals
An
individual whose span of TMA was interrupted because the individual
became eligible for coverage under paragraph (B) of this rule is eligible for
any remaining months of the original TMA span if the individual subsequently
loses eligibility under paragraph (B) of this rule due to an increase in earned
income and does not meet the criteria in paragraph (C)(1)(a) of this
rule.
(4) Repeated spans
of eligibility. There is no limit to the number of times an individual may
receive coverage under TMA or EMA, provided the individual meets all of the
relevant criteria for the coverage each time.
(D) Quarterly request for financial
information for TMA. The parent or caretaker relative must report their gross
earned income and employment-related child care expenses (if applicable)
quarterly to the administrative agency by the fifth business day of the fourth,
seventh, and tenth months of TMA coverage.
(E)(D) Administrative
agency responsibilities. The administrative agency must:
(1) Calculate a parent's or caretaker
relative's family size and household income as described in rule
5160:1-4-01
of the Administrative Code for parent or caretaker relative eligibility.
(2) Send a quarterly request for
financial information to the parent or caretaker relative no later than the
third week of the third, sixth, and ninth month of TMA
coverage.
(3) Update the electronic
eligibility system with information reported from the quarterly request for
financial information.
(4)(2) Determine
eligibility for the second six-month period of TMA.
(5)(3) Consider an
individual's eligibility for TMA or EMA as part of the renewal and
pre-termination review processes described in rule
5160:1-2-01
of the Administrative Code.
(a) Verify in the
electronic eligibility system the individual was receiving medical assistance
in previous months. Approve TMA or EMA if an individual meets the requirements
in paragraph (C) of this rule;
(b)
Deny TMA or EMA when the parent or caretaker
relative:
(i)
No longer has earned income for TMA; or
(ii)
No longer
collects spousal support for EMA.
(c)
Terminate TMA or
EMA when the parent or caretaker relative becomes eligible for another medical
assistance covered group.
(b) Deny or terminate TMA or EMA
when:
(i) There is no longer a dependent
child under the age of eighteen residing with the parent or caretaker relative,
or
(ii) The parent or caretaker
relative:
(a)
Becomes eligible for another medical assistance
covered group, or
(b)
No longer has earned income for TMA,
or
(c)
No longer collects spousal support for EMA,
or
(d)
Fails to report gross earned income and
employment-related child care expenses (if applicable) quarterly for TMA,
or
(e)
Is over income for the second six-month period of
TMA, or
(f)
Receives four months of EMA, or
(g)
Receives twelve months of TMA.
Notes
Ohio Admin. Code
5160:1-4-05
Effective:
12/14/2020
Five Year Review (FYR) Dates:
9/29/2020 and
12/14/2025
Promulgated
Under: 111.15
Statutory
Authority: 5162.03,
5163.02
Rule
Amplifies: 5162.03,
5163.02
Prior
Effective Dates: 04/01/1990 (Emer.), 06/22/1990, 10/01/1990, 01/01/1993,
04/21/1994, 10/31/1997 (Emer.), 01/26/1998, 06/01/2002, 08/30/2002, 08/04/2003,
01/01/2008, 01/01/2010, 10/01/2013, 01/01/2016, 12/19/2016, 07/01/2018,
07/08/2020 (Emer.)
