Ohio Admin. Code 5160:1-6-01.1 - Medicaid: definitions relating to eligibility for long-term care services
For purposes of this chapter the following definitions
apply unless otherwise stated.
"Baseline date" means the first date the individual
both is an institutionalized individual and has applied for medical assistance.
An individual only has one baseline date.
spouse" (CS) means an individual who is not receiving medicaid payment for
long-term care (LTC) services and is married to an institutionalized
"Community spouse resource allowance" (CSRA) means the
amount of a couple's combined countable resources that the community spouse can
keep and do not have to be made available for the care of the institutionalized
"Continuous period of institutionalization"
Thirty consecutive days of being an inpatient in a medical
Thirty consecutive days of being in receipt of home and
community-based (HCBS) waiver or program of all-inclusive care for the elderly
(PACE) services; or
Determined eligible for and in need of HCBS waiver or
PACE services for at least thirty consecutive days.
member" means a natural, adoptive, or step-child, parent, or sibling of the
institutionalized individual who is or could be claimed as a dependent for the
most recent federal tax year by the institutionalized individual, the
institutionalized individual's spouse, or the couple.
allowance standard" (ESA standard) is thirty per cent of the current minimum
monthly maintenance needs allowance (MMMNA) standard.
allowance" (FA) means a required deduction in the computation of patient
liability to provide for the needs of dependent family members who reside with
the community spouse.
"Family maintenance needs allowance" (FMNA) means a
required deduction in the computation of patient liability to provide for the
needs of dependent family members residing in the community when there is no
"Family maintenance needs allowance standard" means the
current Ohio works first payment standard for the same number of applicable
dependent family members.
continuous period of institutionalization" means the first day of the first
month, that began on or after September 30, 1989, in which the individual had a
continuous period of institutionalization as defined in paragraph (A)(4) of
this rule. This is also called the snapshot date.
defined in rule 5160:1-3-05.13 of the Administrative Code.
community-based services" (HCB services or HCBS) means services provided under
a waiver authorized in accordance with
1396n(c) (as in effect
October 1, 2016).
"Improper transfer" means a transfer or disposal of an
asset any time after the look-back date for less than fair market
"Income" is defined in rules 5160:1-3-03.1 and
5160:1-4-01 of the Administrative Code.
means the person requesting or receiving LTC services.
"Institutionalized individual" means an individual who is:
An inpatient in a
long-term care facility (LTCF); or
enrollment in an HCBS waiver by using the special income level (SIL) described
in rule 5160:1-6-03.1 of the Administrative Code.
"Institutionalized spouse" (IS) means an individual who
medical institution and expected to be there for at least thirty consecutive
Eligible for an HCBS waiver or PACE and expected to be
in need of such services for at least thirty consecutive days;
Married to someone who is not in a medical institution,
or eligible for enrollment in an HCBS waiver, or receiving PACE
"Look-back date" means the date that is sixty months
before the individual's baseline date.
facility" (LTCF) means a nursing facility, intermediate care facility for
individuals with intellectual disabilities (ICF-IID), or medical institution
with respect to whom payment is made based on a level-of-care provided in a
"Long-term care (LTC) services" means care provided to
medicaid eligible individuals in a medical institution as defined in paragraph
(A)(21) of this rule, through an HCBS waiver, or through PACE.
institution" means a hospital or LTCF that provides medical care, including
nursing and convalescent care, as defined in
435.1010 (as in effect October 1,
"Minimum monthly maintenance needs allowance standard"
(MMMNA standard) is one hundred fifty per cent of the federal poverty level
(FPL) for a family unit size of two members. The MMMNA standard is updated
annually in accordance with
allowance" (MIA) means a required deduction in the computation of patient
liability to provide for the needs of the community spouse.
allowance" (PNA) means a required deduction in the computation of patient
liability for needs of the individual.
all-inclusive care for the elderly" (PACE) means the program administered by
the department of aging in accordance with Chapter 173-50 of the Administrative
"Restricted medicaid coverage period" (RMCP) means the
period of time an institutionalized individual is ineligible for medicaid
payment of LTC services because of an improper transfer.
level" (SIL) means three hundred per cent of the current supplemental security
income (SSI) payment standard. The SSI payment standard is also referred to as
the federal benefit rate (FBR).
utility allowance" (SUA) is the amount used in lieu of the actual amount of
"Transfer" means any action or failure to act which has
the effect of changing an ownership interest in an asset from one person to
another person or entity, or of preventing an ownership interest that the
person would otherwise have enjoyed. This includes any direct or indirect
method of disposing of an interest in property.
value" means the difference between the fair market value at the time of the
transfer (less any outstanding loans, mortgages, or other encumbrances on the
asset at issue) and the amount received for the resource.
consideration" means that an individual receives in exchange for his or her
right or interest in an asset, some act, object, service, or other benefit
which has tangible and/or intrinsic value to the individual that is roughly
equivalent to or greater than the value of the transferred
Promulgated Under: 111.15
Statutory Authority: 5163.02, 5160.02
Rule Amplifies: 5160.02, 5163.02
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