Ohio Admin. Code 5160:1-4-06 - [Effective1/1/2023]Medicaid: coverage for individuals in receipt of adoption or foster care assistance
(A) This rule
describes eligibility criteria for medical assistance for individuals who are
in receipt of:
(1) Adoption or foster care
assistance under Title IV-E of the Social Security Act (as in effect October 1,
2019
2022 );
or
(2) State foster care
assistance; or
(3) State adoption
assistance subsidies; or
(4) State
adoption assistance in accordance with
42 C.F.R.
435.227 (as in effect October 1,
2019
2022 ).
(B) Individual or authorized representative
responsibilities. The individual or authorized representative must:
(1) Sign and date the application
in accordance with rule
5160:1-2-08 of the
Administrative Code ; and
(2)
Meet the conditions of eligibility described in rule
5160:1-2-10 of the
Administrative Code; and
(3)
Cooperate in establishing eligibility; and
(4) Report changes that impact the
eligibility criteria identified in this rule in accordance with rule
5160:1-2-08 of the
Administrative Code.
(C)
Eligibility criteria for an individual in receipt of adoption or foster care
assistance under Title IV-E of the Social Security Act (as in effect October 1,
2019
2022 ).
(1) The individual must:
(a) Meet the age requirements identified in
Chapter 5101:2-47 of the Administrative Code and be in the custody of a public
children services agency (PCSA), private child placing agency (PCPA), or Title
IV-E agency and in receipt of Title IV-E foster care maintenance payments;
or
(b) Meet the age requirements
identified in Chapter 5101:2-49 of the Administrative Code and have a Title
IV-E adoption agreement in effect, whether or not an adoption assistance
payment is being made or a judicial decree of adoption has been
issued.
(2)
If
When the
individual receives adoption or foster care assistance under Title IV-E of the
Social Security Act and meets the eligibility criteria under this paragraph,
there is no income or resource test required to be eligible for medical
assistance.
(D)
Eligibility criteria for an individual in receipt of
kinship guardianship assistance program (KGAP) payments under Title IV-E of the
Social Security Act (as in effect October 1, 2022).
(1)
The individual
must:
(a)
Meet
the eligibility requirements identified in rule
5101:2-46-02 or rule
5101:2-55-02 of the
Administrative Code; and
(b)
Have a current IV-E KGAP or IV-E kinship guardianship
assistance program connections to twenty-one (KGAP C21) agreement in
effect.
(2)
When the individual receives KGAP payments under Title
IV-E of the Social Security Act and meets the eligibility criteria under this
paragraph, there is no income or resource test required to be eligible for
medical assistance.
(1) The individual must:
(a) Be in the custody of a PCSA, PCPA, or
Title IV-E agency; and
(b) Be in
receipt of state foster care assistance.
(2)
If
When the individual receives state foster care
assistance and meets the eligibility criteria under this paragraph, there is no
income or resource test required to be eligible for medical
assistance.
(1) The individual must:
(a) Meet the age requirements identified in
rule 5101:2-44-06 of the
Administrative Code; and
(b) Have a
state adoption agreement in effect, whether or not a judicial decree of
adoption has been issued.
(2)
If
When the individual receives a state adoption
assistance
maintenance subsidy and meets the eligibility criteria
under this paragraph, there is no income or resource test required to be
eligible for medical assistance.
(1) The individual must:
(a) Be under the age of twenty-one;
and
(b) Have been determined by the
PCSA responsible for determining state adoption maintenance subsidy program
eligibility to have special needs for medical or rehabilitative care that may
be a barrier to the adoptive placement, as described in rule
5101:2-44-05.1 of the Administrative Code,
or have a state adoption subsidy agreement in effect with another state, as
described in rule
5101:2-44-05.2 of the Administrative Code;
and
(c) Have been receiving or
eligible to receive medicaid prior to the execution of the adoption agreement,
under any category of medical assistance.
(2)
If
When the individual receives state adoption
assistance, has special needs for medical or rehabilitative care, and meets the
eligibility criteria under this paragraph, there is no income or resource test
required to be eligible for medical assistance.
(H)
An individual who
meets eligibility requirements identified in rule
5101:2-56-02 of the
Administrative Code and is in receipt of state KGAP payments is not eligible
for medical assistance under this rule on the basis of receiving KGAP
payments.
Notes
Promulgated Under: 111.15
Statutory Authority: 5160.02, 5162.03, 5163.02
Rule Amplifies: 5160.02, 5162.03, 5163.02
Prior Effective Dates: 10/01/2013, 03/26/2015, 01/01/2016, 01/01/2017, 07/08/2020 (Emer.), 12/14/2020
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