Ohio Admin. Code 5160:1-3-02 - Medicaid: criteria for age, blindness, or disability
(A)
The medicaid program provides coverage for individuals
who have been determined to meet the criteria for the limiting physical factors
of age, blindness, or disability as set forth in section 1902 of the Social
Security Act (as in effect on October 1, 2016). Age is determined by county
departments of job and family services (CDJFS). Blindness and disability are
determined by either the social security administration (SSA) or the Ohio
department of medicaid (ODM) in accordance with rule 5160:1-3-02.9 of the
Administrative Code. The criteria are as follows:
(1)
Age: A person who
is age sixty-five years or older meets the age requirement for medicaid.
Verification of age is required.
(2)
Blindness: A
person is considered to be blind if he or she has central visual acuity of
20/200 or less in the better eye with correcting glasses, or a limited visual
field of twenty degrees or less in the better eye.
(3)
Disability.
Disability is defined differently for adults and children. An individual is
disabled if the individual is:
(a)
An adult who is unable to do any substantial gainful
activity by reason of any medically determinable physical or mental impairment
or combination of impairments which can be expected to result in death or which
has lasted or can be expected to last for a continuous period of not less than
twelve months.
(b)
A child under the age of eighteen who has a medically
determinable physical or mental impairment or combination of impairments that
causes marked and severe functional limitations, and that can be expected to
cause death or that has lasted or can be expected to last for a continuous
period of not less than twelve months. No individual under the age of eighteen
who engages in substantial gainful activity may be considered
disabled.
(B)
If SSA makes a
finding of presumptive disability based upon the available evidence which
reflects a high degree of probability that the individual will meet the
disability requirements, the applicant for medical assistance meets the
disability requirements necessary to qualify for medical assistance. If it is
later determined that the SSA decision was erroneously made and the individual
was without fault in the determination, no attempt shall be made to recover
payments for medical assistance made on behalf of the individual.
Replaces: 5160:1-3-02
Notes
Promulgated Under: 111.15
Statutory Authority: 5160.02, 5163.02
Rule Amplifies: 5160.02, 5163.02
Prior Effective Dates: 9/3/77, 1/1/81, 9/6/84, 8/1/85, 8/1/86 (Emer.), 10/3/86, 7/1/87 (Emer.), 8/3/87, 1/1/88 (Emer.), 3/28/88, 10/1/88 (Emer.), 12/20/88, 4/1/90, 10/1/91 (Emer.), 12/1/91, 12/2/91, 12/20/91, 1/1/92 (Emer.), 3/20/92, 12/22/92 (Emer.), 1/1/93 (Emer.), 2/11/93, 3/20/93, 9/1/93, 8/1/95 (Emer.), 10/30/95, 4/1/99, 10/1/02, 11/25/02, 1/1/05, 1/22/15, 8/1/16
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