Ohio Admin. Code 5160:1-6-03.1 - Medicaid: determining financial eligibility for medical assistance using the special income level
(A) This rule describes how to determine
financial eligibility for medical assistance using the special income level
(SIL). This rule does not describe how to determine nonfinancial eligibility
criteria for medical assistance or for medicaid payment of longterm care
services.
(B) An individual,
regardless of age, who is ineligible under base eligibility due to excess
income may be income eligible for medical assistance if his or her income is
less than or equal to the SIL. The SIL is equal to three hundred per cent of
the current supplemental security income (SSI) benefit payment rate for an
individual.
(C) An individual who
is income eligible under the SIL must also meet the resource requirements in
rules 5160:1-3-05.1 and
5160:1-6-04 of the
Administrative Code, as applicable, before his or her application for medical
assistance can be approved.
(D)
Only an individual who has been institutionalized for a continuous period of
institutionalization, as defined in rule
5160:1-6-01.1 of the
Administrative Code, may have his or her income eligibility determined using
the SIL.
(E) When the individual is
eligible under the SIL, eligibility for medical assistance will begin the first
day of the month in which the continuous period of institutionalization
began, and last, assuming all other eligibility
criteria are met, until the individual is no longer institutionalized or
receiving home and community-based (HCBS) or program of all-inclusive care for
the elderly (PACE) services .
(F) When the individual is eligible under the
SIL, the administrative agency shall calculate a patient liability in
accordance with rules
5160:1-6-07 and
5160:1-6-07.1 of the
Administrative Code, as applicable. The individual must pay the calculated
patient liability to the long-term care (LTC) provider as applicable.
(G) When an individual's countable income is
greater than the SIL, the individual may establish a qualified income trust
(QIT) in accordance with rule
5160:1-6-03.2 of the
Administrative Code to reduce his or her countable income to or below the
SIL.
(H) Determine whether an
individual's income is at or below the SIL as follows:
(1) Total only the individual's gross income,
earned and unearned as defined in rule
5160:1-1-01 of the
Administrative Code (do not include parental or spousal income), then exclude
the following income types:
(a) Payments not
considered income, in accordance with
20 C.F.R.
416.1103 (as in effect October 1,
2022
2023 ),
which includes veterans administration aid and attendance.
(b) Payments to victims of Nazi
persecution.
(c) Austrian social
insurance payments based, in whole or in part, on wage credits received under
the provisions of the Austrian General Social Insurance Act, paragraphs 500
through 506 (as in effect October 1, 2022
2023 ). These
payments need to be documented and identifiable separate from countable
insurance.
(d) Payments from the
Dutch government under the Netherlands' Benefit Act for victims of persecution
from 1940-1945 (Dutch acronym, WUV) (Pub. L. No.
103-286 ).
(e) Restitution payments under the Civil
Liberties Act of 1988, to U.S. citizens of Japanese ancestry and permanent
resident Japanese non-citizens who were interned during World War II, or their
survivors, in accordance with
50 U.S.C.
4215 (as in effect October 1,
2022
2023 ).
(f)
Restitution payments under the Aleutian and Pribilof Island Restitution Act, in
accordance with 50 U.S.C.
4236 (as in effect October 1,
2022
2023 ).
(g)
Agent Orange settlement fund payments received on or after January 1, 1989, as
a result of the Agent Orange Compensation Exclusion Act (Pub. L. No.
101-201 ).
(h) Department of defense payments to certain
persons captured and interned in North Vietnam, in accordance with the
Departments of Labor, Health and Human Services, and Education, and Related
Agencies Appropriations Act of 1998 (Pub. L. No.
105-78 ).
(i) Radiation exposure compensation trust
fund payments, in accordance with the Radiation Exposure Compensation Act of
1990 (Pub. L. No.
101-426 ).
(j) Veterans affairs payments made to or on
behalf of:
(i) Certain Vietnam veterans'
natural children regardless of age or marital status, for any disability
resulting from spina bifida suffered by such children;
(ii) Certain Korea service veterans' natural
children regardless of age or marital status, for any disability resulting from
spina bifida suffered by such children; and
(iii) The natural children, regardless of age
or marital status, with certain birth defects born to a woman who served in
Vietnam.
(k) Payments
made to Native Americans as listed in section IV of
20 C.F.R.
416 Subpart K Appendix (as in effect October
1, 2022
2023 ).
(l)
Residential state supplement (RSS) payments to individuals, in accordance with
rule 5160:1-5-01 of the
Administrative Code.
(m) Payments
from a state compensation fund for victims of crime.
(n) Payments made from any fund established
pursuant to a class action settlement in the case of "Factor VIII or IX
concentrate blood products litigation," MDL986, no. 93-C-7452 (N.D. Ill), per
section 4735 of the Balanced Budget Act of 1997 (Pub. L. No.
105-33 ).
(o) Payments from the Ricky Ray Hemophilia
Fund Act of 1998 (Pub. L.
No. 105-369 ) or payments made from any fund
established pursuant to a class settlement in the case of Susan Walker v. Bayer
Corporation, 96-C-5024 (N.D. III).
(p) Payments made to individuals under the
Energy Employees Occupational Illness Compensation Program Act of 2000
(Pub. L. No.
106-398 ).
(q) Assistance (other than wages or salaries)
under the Older Americans Act of 1965 (Pub. L. No. 89-73 ).
(r) Student financial assistance received
under the Higher Education Act (HEA) of 1965 (as in effect October 1,
2022
2023 ) or
bureau of Indian affairs is excluded from income, regardless of use:
(i) Pell grants;
(ii) Student services incentives;
(iii) Academic achievement incentive
scholarships;
(iv) Federal
supplemental education opportunity grants;
(v) Federal educational loans (Stafford
loans, William D. Ford federal direct and direct PLUS loans, etc.);
(vi) Upward bound;
(vii) Gear up (gaining early awareness and
readiness for undergraduate programs);
(viii) State educational assistance programs
funded by the leveraging education assistance programs; and
(ix) Work-study programs.
(s) Matching funds that are deposited into
individual development accounts (IDAs), either demonstration project or
TANF-funded, in accordance with
42 U.S.C.
604 (as in effect October 1,
2022
2023 ).
(t)
Accounts under the Stephen Beck, Jr., Achieving a Better Life Experience (ABLE)
Act of 2014 (Pub. L. No.
113-295 ). The following are not considered income
to the account holder:
(i) Contributions to an
ABLE account by another individual or third party.
(ii) Interest earned on an ABLE
account.
(iii) Distributions from
an ABLE account.
(u)
Federal and state foster care payments received under title IV-B or title IVE
for a child currently living in the household.
(v) Federal or state adoption assistance
payments received under title IV-B or title IV-E.
(w) Payments received under the kinship
guardianship assistance program (KGAP), state KGAP, or kinship guardianship
assistance program connections to twenty-one (KGAP C21).
(x) Child care assistance under the Child
Care and Development Block Grant Act of 1990 (Pub. L. No. 113-186 ).
(y) Assistance or services received through
the domestic volunteer service under
42 U.S.C.
66 per
42 U.S.C.
5044(f) (as in effect
October 1, 2022
2023 ).
(z)
Payments made for supporting services or reimbursement of out-of-pocket
expenses to volunteers participating in corporation for national and community
services (CNCS, formerly ACTION) programs in accordance with
42 U.S.C.
1382a (as in effect October 1,
2022
2023 ):
(i) AmeriCorps VISTA program;
(ii) Special and demonstration volunteer
programs;
(iii) Retired senior
volunteer program (RSVP);
(iv)
Foster grandparents program; and
(v) Senior companion program.
(aa) Assistance or services
received through federal food and nutrition programs:
(i) Supplemental nutrition assistance program
(SNAP);
(ii) The value of foods
donated by the U.S. department of agriculture commodity supplemental food
program;
(iii) The value of
supplemental food assistance received under the Child Nutrition Act of 1966
(Pub. L. No.
89-642 ) and the special food service program for
children under the National School Lunch Act (Pub. L. No. 90-302 );
(iv) The special supplemental nutrition
program for women, infants, and children (WIC); and
(v) Nutrition program benefits provided for
the elderly under Title VII of the Older Americans Act of 1965 (Pub. L. No.
89-73 ).
(bb) Assistance received under the Robert T.
Stafford Disaster Relief and Emergency Assistance Act (Pub. L. No.
100-707 ) and assistance provided under any federal
statute because of a presidentially-declared disaster.
(cc) Assistance, with respect to the dwelling
unit occupied by such individual (or such individual and spouse), under the
United States Housing Act of 1937 (Pub. L. No. 75-412 ), the
National Housing Act (Pub.
L. No. 73-479 ), section 101 of the Housing and
Urban Development Act of 1965 (Pub. L. No. 89-117 ), title V of
the Housing Act of 1949 (Pub. L. No. 81-171), or section 202(h) of the Housing
Act of 1959 (Pub. L. No.
86-372 ).
(dd) Home energy assistance provided on the
basis of need, in accordance with
20 C.F.R.
416.1157 (as in effect October 1,
2022
2023 ).
(ee) Relocation assistance provided under
title II of the Uniform Relocation Assistance and Real Property Acquisitions
Policies Act of 1970 (Pub.
L. No. 91-646 ) provided to individuals displaced
by or through any federal, federally-assisted, state, state-assisted, local, or
locally-assisted government project in the acquisition of real
property.
(ff) The first two
thousand dollars per calendar year received as compensation for participation
in clinical trials that meet the criteria detailed in section 1612(b) of the
Social Security Act (as in effect October 1, 2022
2023 ).
(2) Compare the individual's gross
countable income computed in paragraph (H)(1) of this rule to the
SIL.
(3) When the individual's
countable income is less than or equal to the SIL then the individual is income
eligible for medical assistance.
Notes
Promulgated Under: 111.15
Statutory Authority: 5163.02
Rule Amplifies: 5163.02
Prior Effective Dates: 06/01/1988 (Emer.), 08/01/1988 (Emer.), 10/30/1988, 01/01/1990 (Emer.), 03/01/1990 (Emer.), 03/30/1990 (Emer.), 04/01/1990, 06/29/1990, 07/01/1990, 10/01/1990, 01/01/1991 (Emer.), 04/01/1991, 01/01/1992 (Emer.), 03/20/1992, 05/01/1992 (Emer.), 07/01/1992, 08/14/1992 (Emer.), 11/01/1992, 05/01/1993, 09/01/1993, 07/01/1994, 01/01/1995 (Emer.), 03/20/1995, 10/01/1995, 04/01/1996, 01/01/1997 (Emer.), 02/09/1997, 12/31/1997 (Emer.), 02/01/1998, 04/01/1999, 01/01/2000, 01/01/2001, 05/12/2002, 07/01/2005, 01/25/2015, 09/01/2017, 07/08/2020 (Emer.), 12/14/2020, 01/01/2023
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