Ohio Admin. Code 5160:1-4-02 - MAGI-based medicaid: coverage for children younger than nineteen years of age
(A) This rule describes
medicaid
the
eligibility criteria for children
a child from birth until the individual reaches
age nineteen years
of age in accordance with
42 C.F.R.
435.118 (as in effect
July 1, 2014
October
1, 2020 ) for applications for medical assistance.
(B) Definition. "Child," for the purpose of
this rule, means an individual younger than age nineteen years of
age .
(C) Eligibility criteria
for coverage because a newborn child was born to a medicaid-eligible woman
(deemed newborn). In accordance with
42 C.F.R.
435.117 (as in effect
July 1, 2014
October
1, 2020 ), a child is automatically eligible for
medicaid
medical
assistance as of the child's date of birth, and remains eligible until
the child reaches the age of one, provided the birth mother has applied for,
been determined eligible for, and is receiving medicaid
medical
assistance on the date of the child's birth.
(1) Coverage under this paragraph also
applies to newborns under the following circumstances:
(a) When labor and delivery services were
furnished prior to the date of application and the birth mother's medicaid
eligibility is based on retroactive coverage in accordance with
42 C.F.R. 435.915
(as in effect on July 1, 2014
October 1, 2020 ).
(b)
While
When the birth
mother is receiving alien emergency medical assistance (AEMA) in accordance
with rule
5160:1-5-06
of the Administrative Code.
(c)
While
When the
birth mother is residing in a public institution and is:
(i) Restricted from payment of services as
referenced in rule
5160:1-1-03
of the Administrative Code,
; and
(ii) Within twelve months
from
of the
date of her most recent medicaid application or renewal.
(d)
While
When the birth
mother is in the custody of a public children services agency (PCSA) or private
child placing agency (PCPA).
(e)
While
When the
birth mother is in receipt of adoption or foster care assistance under Title
IV-E.
(f)
While
When the
birth mother is in receipt of state or federal adoption assistance.
(g) When the birth mother loses medicaid
eligibility after the birth of the newborn.
(h) When the birth mother is no longer a
member of the newborn's household at any time prior to the newborn reaching the
age of one.
(2) For
newborns described in this paragraph, the administrative agency must:
(a) Upon verbal or written notification of
the newborn's birth from any individual or entity reporting the birth:
(i) Verify, in the electronic eligibility
system, that the birth mother was eligible for and received medicaid on the
date of the child's birth, and
(ii)
Approve the child's eligibility for medicaid without delay and without
consideration of household composition or income.
(b) Not require an application for the child
or a renewal of eligibility prior to the month of
the child's first birthday.
(c) Not
require verification of U.S. citizenship or identity.
(d) Complete a renewal
of eligibility when the child reaches the age of
one.
(D)
Eligibility criteria for coverage because an individual is a child under
age nineteen years
of age .
(1) A child's family size and
household income shall be calculated as described in rule
5160:1-4-01
of the Administrative Code.
(2)
If
When the
child is not covered by other creditable coverage, the child's household income
must not exceed two hundred six per cent of the federal poverty level for the
family size.
(3)
If
When the
child is covered by other creditable coverage, the child's household income
for the family size must not exceed one
hundred fifty-six per cent of the federal poverty level for the family
size.
(4) A child receiving medical
coverage under this paragraph remains eligible:
(a) Through the end of the month in which the
child turns age nineteen
years of age , if the child remains otherwise
eligible in accordance with rule
5160:1-2-10
of the Administrative Code, and the individual
responsibilities described in rule
5160:1-2-08
of the Administrative Code are met ; or
(b) Until the end of an inpatient stay during
which inpatient services are being furnished, if the child is found eligible
under this paragraph on or after his/her
his or her
eighteenth birthday and turns age nineteen
years of age during the inpatient stay.
Notes
Promulgated Under: 111.15
Statutory Authority: 5160.02, 5161.02, 5161.12, 5162.03, 5163.02, 5163.40
Rule Amplifies: 5160.02, 5161.02, 5161.12, 5162.03, 5163.02, 5163.40
Prior Effective Dates: 10/01/2013, 03/26/2015, 01/01/2016, 01/01/2017
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