Section 5160:1-2-14 - Medicaid: continuous eligibility for children younger than age nineteen(A) This rule describes the twelve-month period of continuous eligibility for a child younger than age nineteen, and the conditions under which the child's coverage ends during the twelve-month period, as described in section 1902(e)(12) of the Social Security Act (as in effect October 1, 2023).(B) Eligibility criteria. A child remains eligible for coverage despite changes in the child's circumstances for a period of twelve months when the child was found to be eligible for a category of medical assistance other than:(1) Presumptive eligibility as described in rule 5160:1-2-13 of the Administrative Code;(2) Non-citizen emergency medical assistance as described in rule 5160:1-5-06 of the Administrative Code; or(3) Refugee medical assistance as described in rule 5160:1-5-05 of the Administrative Code.(C) Duration.(1) A child's twelve-month period of continuous eligibility begins:(a) On the date that medical assistance began as a result of an initial determination or annual renewal in accordance with rule 5160:1-2-01 of the Administrative Code.(b) Any months of retroactive eligibility received by the child are not included in the twelve-month period of continuous eligibility.(2) The child's coverage shall be terminated during the continuous eligibility period only: (a) Upon oral or written request of the child ( when the child is at least eighteen years old) or the child's representative; or(b) When the child: (i) No longer resides in the state of Ohio; or(iii) Has not paid the premium amounts required for coverage, when the child is covered under the medicaid buy-in for workers with disabilities category described in rule 5160:1-5-03 of the Administrative Code; or(iv) Reaches the age of nineteen.(D) Patient liability, or premium. A patient liability or premium calculated for a child in accordance with Chapters 5160:1-3 to 5160:1-6 of the Administrative Code shall not increase during the child's continuous coverage period. Any decrease in a child's patient liability or premium results in a new maximum amount, which will not increase for the remainder of the child's continuous coverage period.(E) Regardless of a child's status under this rule, payment for services shall not be made when payment is prohibited under rule 5160:1-1-03 of the Administrative Code.Ohio Admin. Code 5160:1-2-14
Effective: 11/1/2023
Five Year Review (FYR) Dates: 7/28/2023 and 11/01/2028
Promulgated Under: 111.15
Statutory Authority: 5162.031, 5163.02
Rule Amplifies: 5163.02, 5163.03
Prior Effective Dates: 04/01/2010 (Emer.), 07/01/2010, 10/15/2010, 01/01/2014, 08/01/2016, 07/08/2020 (Emer.), 12/14/2020