Ohio Administrative Code

11.15 PDF: (A) This rule describes the treatment of cash, checking and savings accounts, and time deposits for the purpose of determining eligibility for medical assistance.(B) Definitions.(1) "Cash" means money on hand or available in the form of currency or coins. Foreign curre…

11.15 PDF: (A) This rule describes the treatment of promissory notes, property agreements, and loans for the purpose of determining eligibility for medical assistance.(B) Definitions.(1) "Promissory note" means a written, unconditional promise signed by a person to pay a specifie…

11.15 PDF: (A) This rule describes the treatment of burial funds and burial contracts for the purpose of determining eligibility for medical assistance.(B) Definitions.(1) "Burial funds" are revocable burial contracts, revocable burial trusts, other revocable burial arrangements …

11.15 PDF: (A) This rule describes the treatment of burial spaces for the purpose of determining eligibility for medical assistance.(B) Definitions.(1) "Agreement," for the purpose of this rule, means a contract with a burial provider for a burial space held for the individual or…

11.15 PDF: (A) This rule describes the treatment of lump-sum payments for purposes of determining eligibility for medical assistance.(B) Definition. "Lump-sum payment" means income which is accrued over two or more months or a money payment which is not related to any time period…

11.15 PDF: (A) This rule describes the treatment of dividends and interest for the purpose of determining eligibility for medical assistance.(B) Definitions. "Dividends" and "interest", for the purpose of this rule, are returns on financial institution accounts. A cash gift or in…

11.15 PDF: (A) This rule describes household composition and income calculations under 42 C.F.R. 435.603 (as in effect October 1, 2025) when determining an individual's eligibility for modified adjusted gross income (MAGI) based medical assistance. This rule does not apply to det…

11.15 PDF: (A) This rule describes the eligibility criteria for a child from birth until the individual reaches nineteen years of age in accordance with 42 C.F.R. 435.118 (as in effect October 1, 2025) for applications for medical assistance. (B) Definition. "Child" means an indi…

11.15 PDF: (A) This rule describes the eligibility criteria for applications for medical assistance for individuals:(1) Who are nineteen or twenty years of age; or(2) Who aged out of foster care, are younger than twenty-six years of age, and are not otherwise eligible for a manda…

11.15 PDF: (A) This rule describes eligibility for pregnant individuals as described in 42 C.F.R. 435.116 (as in effect on October 1, 2023) for applications for medical assistance.(B) Eligibility criteria for coverage because an individual is pregnant.(1) The individual must be f…

11.15 PDF: (A) This rule describes the eligibility requirements for parents and caretaker relatives residing with children as described in 42 C.F.R. 435.110 (as in effect October 1, 2024), transitional medical assistance as described in section 1925 of the Social Security Act (as…

11.15 PDF: (A) This rule describes eligibility criteria for medical assistance for individuals who are in receipt of:(1) Adoption or foster care assistance under Title IV-E of the Social Security Act (as in effect October 1, 2023); or(2) State foster care assistance; or(3) State …

11.15 PDF: (A) RSS provides cash assistance to aged, blind, or disabled adults who are eligible for medical assistance and who have increased needs due to a medical condition which is not severe enough to require institutionalization. The RSS cash payment is used together with th…

11.15 PDF: (A) This rule describes the medicaid breast and cervical cancer project.(B) Rules 5160:1-5-02 to 5160:1-5-02.4 of the Administrative Code set forth the eligibility requirements for participation in the breast and cervical cancer project. The Breast and Cervical Cancer …

11.15 PDF: (A) This rule contains definitions generally used for BCCP.(B) Definitions.(1) "Breast and Cervical Cancer Project (BCCP) medicaid" means the category of medicaid for qualified individuals in need of treatment for breast or cervical cancer, including pre-cancerous cond…

11.15 PDF: (A) This rule describes the eligibility criteria for BCCP medicaid.(B) An individual shall meet all of the following criteria to be eligible for BCCP medicaid:(1) Be screened for breast or cervical cancer under the national breast and cervical cancer early detection pr…

11.15 PDF: (A) This rule describes the application and renewal process for the breast and cervical cancer project (BCCP).(B) The BCCP medicaid application and renewal process shall:(1) Be coordinated between the Ohio department of medicaid (ODM), Ohio department of health (ODH) B…

11.15 PDF: (A) This rule governs the eligibility requirements for the medical assistance programs authorized under sections 1902(a)(10)(A)(ii)(XV) and (XVI) of the Social Security Act (as in effect October 1, 2025). Medicaid buy-in for workers with disabilities (MBIWD) enables ce…

11.15 PDF: (A) This rule governs the eligibility requirements for the medical assistance program authorized under section 1902(a)(10)(A)(ii)(XIII) of the Social Security Act (as in effect October 1, 2025). Ohio workability enables certain working disabled individuals aged sixty-f…

11.15 PDF: (A) This rule describes a time-limited medical assistance program, funded through the office of refugee resettlement (ORR), that provides a medical screening through contracted refugee health screening providers and other medical services. There is no resource limit fo…

11.15 PDF: (A) In accordance with 42 U.S.C. 1396b(v), this rule describes eligibility criteria for coverage of the treatment of an emergency medical condition for certain individuals who do not meet the medicaid citizenship or satisfactory immigration status requirements describe…

11.15 PDF: (A) This rule sets forth the eligibility criteria for a state plan home and community-based services (HCBS) benefit authorized under section 1915(i) of the Social Security Act (as in effect October 1, 2024). Section 1915(i) allows states the flexibility to provide HCBS…

11.15 PDF: (A) This rule describes the eligibility requirements for state-funded medical assistance for a non-citizen victim of a severe form of human trafficking.(B) For purposes of this rule the following definitions apply unless otherwise stated.(1) "Labor trafficking" means r…

11.15 PDF: (A) This rule describes how an individual is determined eligible for medicaid payment for long-term care (LTC) services.(B) In order to receive medicaid payment for LTC services, the individual must:(1) Be eligible for medical assistance in accordance with Chapter 5160…

11.15 PDF: (A) For purposes of this chapter the following definitions apply unless otherwise stated.(1) "Baseline date" means the first date the individual both is an institutionalized individual and has applied for medical assistance. An individual only has one baseline date.(2)…

11.15 PDF: (A) This rule describes the application of resource rules when an individual is requesting or receiving medicaid payment for long-term care (LTC) services.(B) Individuals requesting or receiving medicaid payment for LTC services are subject to the following resource ru…

11.15 PDF: (A) This rule describes the treatment of the home equity limit for an individual requesting or receiving medicaid payment for long-term care (LTC) services.(B) Definition. "Home equity limit" means the maximum amount of equity which an individual could have in the home…

11.15 PDF: (A) This rule describes the qualified long-term care partnership (QLTCP) program.(B) Definitions.(1) "Estate recovery" means the program set forth in rule 5160:1-2-07 of the Administrative Code.(2) "Qualified long-term care partnership" (QLTCP) means the program establ…

11.15 PDF: (A) The purpose of this rule is to describe the eligibility requirements for individuals residing in a continuing care retirement community (CCRC), life care community, or a philanthropic long-term care facility (PLTCF).(B) Definitions.(1) "CCRCs" and "life care commun…

11.15 PDF: (A) The following income rules apply when an individual, regardless of age, is seeking medicaid payment for long-term care services.(1) An individual ineligible for base eligibility due to excess income shall have his or her income eligibility determined using the spec…

11.15 PDF: (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 non-financial eligibility criteria for medical assistance or for medicaid payment of long-term care …

11.15 PDF: (A) This rule sets forth the requirements that must be met in order to establish and use a qualified income trust (QIT) (also referred to as a Miller trust) to become eligible for medicaid payment of long-term care services.(B) Definitions(1) "Beneficiary" is defined i…

11.15 PDF: (A) This rule describes how to treat the income and resources of the institutionalized spouse (IS) and the community spouse (CS) for purposes of determining eligibility of the IS. When determining eligibility under this rule, the income and resources deeming provisions…

11.15 PDF: (A) This rule describes the treatment of income and resources for spouses who are both seeking medicaid payment for LTC services.(B) When both spouses are expected to receive LTC services for less than thirty consecutive days, each spouse's eligibility must be determin…

11.15 PDF: (A) This rule implements section 1917 of the Social Security Act (as in effect October 1, 2025) and describes the treatment of transfers of assets when an institutionalized individual, as defined in rule 5160:1-6-01.1 of the Administrative Code, is seeking medicaid pay…

11.15 PDF: (A) This rule describes the treatment of annuity purchases and transactions when an institutionalized individual is requesting medicaid payment for long-term care (LTC) services.(B) The institutionalized individual, or his or her spouse, must disclose any interest that…

11.15 PDF: (A) This rule describes when transfers, by an institutionalized individual or his or her spouse, involving a trust are considered improper and subject to a restricted medicaid coverage period (RMCP) in accordance with rule 5160:1-6-06.5 of the Administrative Code.(B) T…

11.15 PDF: (A) This rule describes the treatment of transfers involving life estates when an institutionalized individual is requesting medicaid payment for long-term care services.(B) The following steps must be taken to determine whether a transfer involving a life estate, as d…

11.15 PDF: (A) This rule describes how to treat transfers involving promissory notes, property agreements, and loans held by an institutionalized individual, or his or her spouse, when the institutionalized individual is requesting medicaid payment for long-term care (LTC) servic…

11.15 PDF: (A) This rule describes how to calculate and apply a restricted medicaid coverage period (RMCP), which is the period of time that long-term care (LTC) services will not be paid for by medicaid because the institutionalized individual improperly transferred an asset.(B)…

11.15 PDF: (A) This rule describes an undue hardship exemption for institutionalized individuals who are subject to a restricted medicaid coverage period (RMCP) described in rule 5160:1-6-06.5 of the Administrative Code.(B) The institutionalized individual will not be subject to …

11.15 PDF: (A) This rule describes the social security administration's (SSA) reporting requirements to the Ohio department medicaid (ODM) regarding alleged transfer of assets by supplemental security income (SSI) applicants.(B) When an individual applies for SSI benefits, the SS…

11.15 PDF: (A) This rule describes the disposal of assets of individuals who are receiving services from the Ohio department of developmental disabilities (DODD) and/or the Ohio department of mental health and addiction services (OhioMHAS) and who are in receipt of medical assist…

11.15 PDF: (A) This rule describes how to calculate an institutionalized individual's post-eligibility treatment of income (PETI), commonly referred to as patient liability or share of cost. This rule only applies to an individual residing in a medical institution who does not ha…

11.15 PDF: (A) This rule describes the process for calculating an individual's post-eligibility treatment of income (PETI), commonly referred to as patient liability or share of cost, when the individual is not living in a medical institution. This rule only applies to an individ…

(A) PurposeThis rule sets forth the procedural safeguards in the early intervention program, including the provisions of parental consent and notice; retention, confidentiality, access to, and amendment of records; and dispute resolution.(B) DefinitionsFor the purposes of this ru…

(A) PurposeThis rule sets forth the early intervention program requirements for eligibility, developmental screening, evaluation, assessment, individualized family service plan meetings and content, transition to preschool and other programs, service coordination, early intervent…