Ohio Department of Medicaid Resources and Rules (edited 9/20/2016)
A listing of all proposed rules for the Ohio Department of Medicaid - Register of Ohio
Medicaid Forms     ODM QIT Template & QIT Verification Form
Ohio Medicaid Waiver Comparison Chart - With Enrollment Figures
Medicaid Eligibility Manual Transmittal Letters (MEMTLs) and Medicaid Eligibility Procedure Letters (MEPLs)
OAC 5160:1-2-01(F)(5) is the Pro Seniors' Rule that Medicaid must determine eligibility without considering eligibility factors for which verification cannot be obtained or means of self-support that cannot be accessed because of the physical or mental impairment. Dubose, et al. v. ODJFS, et al., S.D.Ohio (W.D.), No. 1:07-CV-945, filed November 2007.
OAC 5160 Medicaid;     OAC 5160:1 Medicaid General Principals (Individual regulations listed below)
       
Rule Number Most Recent Eff. Date 1634 Change Rule Title
Chapter 5160:1-1 General Medicaid Eligibility Policy
5160:1-1-01 1/1/2016   Medicaid: definitions.
5160:1-1-03 8/1/2016 New Medicaid: restrictions on payment for services.
5160:1-1-04 1/10/2015   Medicaid: income and eligibility verification system (IEVS).
5160:1-1-50 10/1/2013   Medicaid: administrative code rule migration.
5160:1-1-51.1 10/1/2013   Medicaid: safeguarding and releasing information.
5160:1-1-55.1 10/1/2013   Medicaid: authorized representative responsibilities.
5160:1-1-62 4/25/2015   Medicaid: presumptive eligibility.
       
Chapter 5160:1-2 Medicaid Application Processing
General Eligibility      
5160:1-2-01 1/1/2016   Medicaid: administrative agency responsibilities.
5160:1-2-01.9 1/9/2012   Medicaid: income, exemptions, and disregards.
5160:1-2-03 3/23/2015   Medicaid: application for home and community-based (HCB) services.
5160:1-2-04 8/1/2016 New Medicaid: consumer fraud and erroneous payments.
5160:1-2-05 (PDF) ? New Medicaid: certificate of creditable coverage and privacy notice.
5160:1-2-06 8/1/2016 New Medicaid: outstationing workers at disproportionate share hospitals and federally qualified health centers.
5160:1-2-07 1/15/2015   Medicaid: Estate Recovery.
5160:1-2-08 8/1/2016 New Medicaid: individual responsibilities.
5160:1-2-10 8/1/2016 New Medicaid: conditions of eligibility and verification.
5160:1-2-11 8/1/2016 New Medicaid: United States (U.S.) citizenship documentation.
5160:1-2-12 8/1/2016 New Medicaid: non-citizens.
5160:1-2-14 8/1/2016 New Medicaid: continuous eligibility for children younger than age nineteen.
5160:1-2-15 9/12/2016 New Medicaid: Healthchek (Early and Periodic Screening, Diagnostic and Treatment Services).
5160:1-2-16 1/15/2015   Medicaid: pregnancy related services (PRS).
       
       
Chapter 5160:1-3 Medicaid for the Aged, Blind, or Disabled (ABD)
ABD Coverage      
5160:1-3-01 4/15/2016 New Medicaid: coverage for the aged, blind, or disabled.
       
Base Eligibility Requirements of the ABD eligibility covered groups  
5160:1-3-02 8/1/2016 New Medicaid: criteria for age, blindness, or disability.
5160:1-3-02.1 8/1/2016 New Medicaid premium assistance program (MPAP).
5160:1-3-02.2 8/1/2016 New Medicare buy-in.
5160:1-3-02.3 8/1/2016 New Medicaid: coverage for individuals receiving supplemental security income (SSI) benefits.
5160:1-3-02.4 8/1/2016 New Medicaid: coverage for the categorically needy.
5160:1-3-02.5 8/1/2016 New Medicaid: supplemental security income (SSI) recipients qualifying under section 1619 of the Social Security Act for continued medical assistance coverage.
5160:1-3-02.6 8/1/2016 New Medicaid: grandfathering provisions and deemed eligibility.
5160:1-3-02.7 1/1/2016   Medicaid: continuing care communities, life care communities and philanthropic long-term care facilities.
5160:1-3-02.8 12/1/2014   Medicaid: treatment of qualified long-term care insurance policies.
5160:1-3-02.9 8/1/2016 New Medicaid: disability determination process.
       
Income      
5160:1-3-03.1 8/1/2016 New Medicaid: income.
5160:1-3-03.2 8/1/2016 New Medicaid: income exclusions.
5160:1-3-03.3 8/1/2016 New Medicaid: deeming of income.
5160:1-3-03.5 8/1/2016 New Medicaid: application of income standards.
5160:1-3-03.6 8/1/2016 Amendment Medicaid: treatment of rental income.
5160:1-3-03.7 8/1/2016 Amendment Medicaid: treatment of sick pay and sick leave.
5160:1-3-03.8 8/1/2016 Amendment Medicaid: in-kind support and maintenance.
5160:1-3-03.10 8/1/2016 New Medicaid: retirement funds.
       
Patient Liability & Special Income Level  
5160:1-3-04.1 8/1/2016 Amendment Medicaid: eligibility through the spenddown process.
5160:1-3-04.2 1/25/2015   Medicaid: income computations for determining eligibility using the special income level.
5160:1-3-04.3 1/1/2016   Medicaid: determining patient liability.
5160:1-3-04.4 1/1/2016   Medicaid: income and patient liability determinations for individuals under the assisted living home and community based waiver.
       
Resources      
5160:1-3-05.1 8/1/2016 New Medicaid: resource requirement.
5160:1-3-05.2 8/1/2016 Amendment Medicaid: trusts.
5160:1-3-05.3 8/1/2016 New Medicaid: the disclosure and treatment of annuities for medical assistance programs.
5160:1-3-05.4 8/1/2016 Amendment Medicaid: cash and checking and savings accounts and time deposits.
5160:1-3-05.5 8/1/2016 New Medicaid: promissory notes, property agreements, and loans.
5160:1-3-05.6 8/1/2016 New Medicaid: burial funds and contracts.
5160:1-3-05.7 8/1/2016 New Medicaid: burial spaces.
5160:1-3-05.8 8/1/2016 Amendment Medicaid: lump-sum payments.
5160:1-3-05.9 8/1/2016 New Medicaid: dividends and interest.
5160:1-3-05.10 8/1/2016 New Medicaid: household goods and personal effects as resources.
5160:1-3-05.11 8/1/2016 Amendment Medicaid: automobiles and other modes of transportation as resources.
5160:1-3-05.12 8/1/2016 New Medicaid: life insurance.
5160:1-3-05.13 8/1/2016 New Medicaid: treatment of the home.
5160:1-3-05.14 8/1/2016 New Medicaid: resource exclusion.
5160:1-3-05.16 11/2/2014   Medicaid: home replacement exclusion.
5160:1-3-05.17 11/2/2014   Medicaid: life estates and life leases.
5160:1-3-05.18 8/1/2016 New Medicaid: stocks, mutual funds, and bonds.
5160:1-3-05.19 8/1/2016 Amendment Medicaid: real or personal property essential to self-support.
5160:1-3-05.20 8/1/2016 Amendment Medicaid: deeming of resources.
       
Treatment of Resources for IS with a CS  
5160:1-3-06.1 11/2/2014   Medicaid: treatment of income and resources of institutionalized individuals.
5160:1-3-06.2 11/2/2014   Medicaid: resource assessment.
5160:1-3-06.3 11/2/2014   Medicaid: treatment of resources for institutionalized individuals with a spouse in the community.
5160:1-3-06.4 11/2/2014   Medicaid: resource budgeting methodology for institutionalized individuals with a spouse in the community.
5160:1-3-06.5 11/2/2014   Medicaid: transfer of resources for institutionalized spouses with a spouse in the community.
       
Transfer of Resources    
5160:1-3-07.1 1/15/2015   Medicaid: social security administration reporting alleged transfer of resources by supplemental security income (SSI) applicants to the Ohio department of medicaid (ODM).
5160:1-3-07.2 1/1/2016   Medicaid: transfer of resources.
5160:1-3-07.3 1/15/2015   Medicaid: disposal of resources for Ohio department of developmental disabilities and/or Ohio department of mental health and addiction services individuals.
       
MAGI-based Medicaid    
5160:1-4-01 8/1/2016 Amendment MAGI-based medicaid: income and household income.
5160:1-4-02 1/1/2016   MAGI-based medicaid: coverage for children younger than age nineteen.
5160:1-4-03 1/1/2016   MAGI-based medicaid: coverage for Ribicoff and former foster care adults.
5160:1-4-04 1/1/2016   MAGI-based medicaid: coverage for pregnant women.
5160:1-4-05 1/1/2016   MAGI-based medicaid: coverage for a parent or caretaker relative residing with a child.
       
Chapter 5160:1-5 Medicaid for Other Covered Groups
Special Programs      
5160:1-5-01 8/1/2016 New Medicaid: the residential state supplement (RSS) program.
5160:1-5-02 3/23/2015   Medicaid: breast and cervical cancer project (BCCP).
5160:1-5-02.1 3/23/2015   Medicaid: breast and cervical cancer project (BCCP) definitions.
5160:1-5-02.2 3/23/2015   Medicaid: breast and cervical cancer project (BCCP): eligibility requirements.
5160:1-5-02.3 3/23/2015   Medicaid: breast and cervical cancer project (BCCP) eligibility period.
5160:1-5-02.4 3/23/2015   Medicaid: breast and cervical cancer project (BCCP): application and redetermination process.
5160:1-5-03 3/23/2015   Medicaid: medicaid buy-in for workers with disabilities (MBIWD).
5160:1-5-05 3/23/2015   Medicaid: refugee medical assistance (RMA).
5160:1-5-06 8/1/2016 New Medicaid: alien emergency medical assistance (AEMA).
5160:1-5-07 8/1/2016 New Medicaid: Specialized recovery services (SRS) program.
       
Chapter 5160:1-6 Long-Term Care  
QITs      
5160:1-6-03.2 5/16/2016 New Medicaid: use of qualified income trusts (QIT).