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Ohio Statutes, Title 51

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Ohio/Statutes

← All Ohio coverage

Title 51, Public Welfare

31 chapters · 2,012 sections in this title.

All chapters in Title 512,012 Ch 5123, Department of Developmental Disabilities182 Ch 5101, Department of Job and Family Service…145 Ch 5119, Department of Behavioral Health121 Ch 5120, Department of Rehabilitation and Cor…121 Ch 5165, Medicaid Coverage of Nursing Facilit…116 Ch 5103, Placement of Children113 Ch 5164, Medicaid State Plan Services113 Ch 5126, County Boards of Developmental Disab…111 Ch 5180, Department of Children and Youth94 Ch 5124, Intermediate Care Facility for Indiv…80 Ch 5153, County Children Services72 Ch 5104, Child Day-care69 Ch 5162, Medicaid and Medicaid Funds67 Ch 5168, Hospital Care Assurance Program; Hea…66

2,012 sections·Filtered byTitle 51✕

Ohio Rev. Code Ann. § 5162.90 Use of automated review tools
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(A) As used in this section: (1) "Artificial intelligence" means a machine-based system that, for explicit or implicit objectives, infers, from the input it receives, how to generate outputs such as predictions, content, recommendations, or decisions that can influence physical o…
Ohio Rev. Code Ann. § 5163.01 Definitions
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As used in this chapter: "Caretaker relative" has the same meaning as in 42 C.F.R. 435.4 as that regulation is amended effective January 1, 2014. "Expansion eligibility group" means the medicaid eligibility group described in section 1902(a)(10)(A)(i)(VIII) of the "Social Securit…
Ohio Rev. Code Ann. § 5163.02 Rules establishing eligibility requirements for medicaid
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The medicaid director shall adopt rules as necessary to implement this chapter. The rules shall establish eligibility requirements for the medicaid program. The rules may establish requirements for applying for medicaid and determining and verifying eligibility for medicaid. The …
Ohio Rev. Code Ann. § 5163.03 Medicaid coverage

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(A) The medicaid program shall cover all mandatory eligibility groups. (B) The medicaid program shall cover all of the optional eligibility groups that state statutes require the medicaid program to cover. (C) The medicaid program may cover any of the optional eligibility groups …

Ohio Rev. Code Ann. § 5163.04 Federal medical assistance percentage for medicaid expansion eligibility group

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(A) If the federal medical assistance percentage for medical assistance provided to members of the expansion eligibility group is set below ninety per cent, the department of medicaid shall do both of the following: (1) Immediately discontinue all medical assistance for members o…

Ohio Rev. Code Ann. § 5163.05 Immigration status eligibility for Medicaid

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No individual is eligible to participate in the medicaid program in this state unless that individual is eligible to participate in the medicaid program under section 1903(v)(5) of the "Social Security Act," 42 U.S.C. 1396b(v)(5).

Ohio Rev. Code Ann. § 5163.06 Optional eligibility groups

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The medicaid program shall cover all of the following optional eligibility groups: (A) The group consisting of children placed with adoptive parents who are specified in section 1902(a)(10)(A)(ii)(VIII) of the "Social Security Act," 42 U.S.C. 1396a(a)(10)(A)(ii)(VIII); (B) Subjec…

Ohio Rev. Code Ann. § 5163.061 Income eligibility threshold for pregnant women

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The income eligibility threshold is two hundred per cent of the federal poverty line for women during pregnancy and the postpartum period beginning on the last day of the pregnancy who are covered by the medicaid program under division (B) of section 5163.06 of the Revised Code.

Ohio Rev. Code Ann. § 5163.063 Medicaid coverage of employed individuals with a disability

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The medicaid director shall adopt rules under section 5163.02 of the Revised Code as necessary to provide medicaid coverage for the optional eligibility group described in section 1902(a)(10)(A)(ii)(XIII) of the "Social Security Act," 42 U.S.C. 1396a(a)(10)(A)(ii)(XIII). By requi…

Ohio Rev. Code Ann. § 5163.07 Income eligibility threshold for parents and caretaker relatives

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The medicaid director shall implement the option authorized by the "Social Security Act," section 1931(b)(2)(C), 42 U.S.C. 1396u-1(b)(2)(C), to set the income eligibility threshold at ninety per cent of the federal poverty line for parents and caretaker relatives who are covered …

Ohio Rev. Code Ann. § 5163.09 Medicaid buy-in for workers with disabilities program

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(A) As used in sections 5163.09 to 5163.098 of the Revised Code: "Applicant" means an individual who applies to participate in the medicaid buy-in for workers with disabilities program. "Earned income" has the meaning established by rules authorized by section 5163.098 of the Rev…

Ohio Rev. Code Ann. § 5163.091 Qualifications for program

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Under the medicaid buy-in for workers with disabilities program, an individual who does both of the following in accordance with rules authorized by section 5163.098 of the Revised Code qualifies for the medicaid program: (A) Applies for the medicaid buy-in for workers with disab…

Ohio Rev. Code Ann. § 5163.092 Resource eligibility limit - annual adjustment

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(A) Except as provided in division (B) of this section, the maximum value of resources, less amounts disregarded pursuant to rules authorized by section 5163.098 of the Revised Code, that an individual may have without the individual exceeding the resource eligibility limit for t…

Ohio Rev. Code Ann. § 5163.093 Individual income eligibility limit

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For the purpose of determining whether an individual is within the income eligibility limit for the medicaid buy-in for workers with disabilities program, all of the following apply: (A) Twenty thousand dollars of the individual's earned income shall be disregarded. (B) No amount…

Ohio Rev. Code Ann. § 5163.094 Amount of annual individual premium

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An individual shall not be required to pay a premium as a condition of qualifying for the medicaid buy-in for workers with disabilities program.

Ohio Rev. Code Ann. § 5163.095 Eligibility not denied due to services received under home and community-based services medicaid waiver component

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No individual shall be denied eligibility for the medicaid buy-in for workers with disabilities program on the basis that the individual receives services under a home and community-based services medicaid waiver component.

Ohio Rev. Code Ann. § 5163.096 Continued participation where employment ceases

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An individual participating in the medicaid buy-in for workers with disabilities program may continue to participate in the program for up to six months even though the individual ceases to have earnings from employment or to be an employed individual with a medically improved di…

Ohio Rev. Code Ann. § 5163.097 Director to make federally required changes

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If the United States secretary of health and human services requires that a provision of the medicaid buy-in for workers with disabilities program be changed or removed in order for the secretary to approve the program or to avoid an extended delay in the secretary's approval, th…

Ohio Rev. Code Ann. § 5163.098 Program implementing rules; disregarded income

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(A) The medicaid director shall adopt rules under section 5163.02 of the Revised Code as necessary to implement the medicaid buy-in for workers with disabilities program. The rules shall do all of the following: (1) Specify assets, asset values, and amounts to be disregarded in d…

Ohio Rev. Code Ann. § 5163.10 Implementation of the presumptive eligibility for pregnant women option

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(A) As used in this section: ( 1) "Presumptive eligibility for pregnant women option" means the option available under section 1920 of the "Social Security Act," 42 U.S.C. 1396r-1, to make ambulatory prenatal care available to pregnant women under the medicaid program during pres…

Ohio Rev. Code Ann. § 5163.101 Implementation of the presumptive eligibility for children option

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(A) As used in this section: (1) "Children's hospital" has the same meaning as in section 2151.86 of the Revised Code. (2) "Federally qualified health center" has the same meaning as in section 1905(l)(2)(B) of the "Social Security Act," 42 U.S.C. 1396d(l)(2)(B). (3) "Federally q…

Ohio Rev. Code Ann. § 5163.103 Presumptive eligibility error rate training

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(A) As used in this section: (1) "Presumptive eligibility error rate" means the rate at which a qualified entity or qualified provider deems an individual presumptively eligible for medicaid under sections 5163.10 to 5163.102 of the Revised Code when the individual is ineligible …

Ohio Rev. Code Ann. § 5163.104 Presumptive eligibility error rate reports

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As used in this section, "presumptive eligibility error rate" has the same meaning as in section 5163.103 of the Revised Code. Quarterly, the department of medicaid shall report to the general assembly the presumptive eligibility error rate for presumptive eligibility determinati…

Ohio Rev. Code Ann. § 5163.11 Medicaid expansion eligibility group redetermination

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To the extent permissible under federal law, the department of medicaid shall redetermine the eligibility of members of the expansion eligibility group for medicaid benefits every six months.

Ohio Rev. Code Ann. § 5163.20 Beneficiary of disability trust

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If a medicaid recipient is the beneficiary of a trust created pursuant to section 5815.28 of the Revised Code, then, notwithstanding any contrary provision of this chapter or of a rule adopted under section 5163.02 of the Revised Code, divisions (C) and (D) of that section shall …

Ohio Rev. Code Ann. § 5163.21 Eligibility determinations for cases involving medicaid programs

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(A)(1) This section applies only to either of the following: (a) Initial eligibility determinations for the medicaid program; (b) An appeal from an initial eligibility determination pursuant to section 5160.31 of the Revised Code. (2)(a) Except as provided in division (A)(2)(b) o…

Ohio Rev. Code Ann. § 5163.22 Life insurance policies

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(A) The general assembly hereby finds that the state has an insurable interest in medicaid recipients because of the state's statutory right to recover from the estate of a recipient state funds used to provide the recipient with medicaid services. (B) As used in this section: (1…

Ohio Rev. Code Ann. § 5163.30 Disposal of assets under market value after look-back date

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(A) As used in this section: (1) "Assets" include all of an individual's income and resources and those of the individual's spouse, including any income or resources the individual or spouse is entitled to but does not receive because of action by any of the following: (a) The in…

Ohio Rev. Code Ann. § 5163.31 Real property not homestead after 13-month institutional residence

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(A) Except as provided by division (A) of this section and for the purpose of determining whether an aged, blind, or disabled individual is eligible for nursing facility services, ICF/IID services, or other medicaid-funded long-term care services, the medicaid director may consid…

Ohio Rev. Code Ann. § 5163.32 Equity interest in home exceeds $500,000

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(A) Except as otherwise provided by this section, no individual shall qualify for nursing facility services or other medicaid-funded long-term care services if the individual's equity interest in the individual's home exceeds five hundred thousand dollars. The medicaid director s…

Ohio Rev. Code Ann. § 5163.33 Deducting personal needs allowance from recipient's income

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(A) In determining the amount of income that a medicaid recipient must apply monthly toward payment of the cost of care in a nursing facility or ICF/IID, a county department of job and family services shall deduct from the recipient's monthly income a monthly personal needs allow…

Ohio Rev. Code Ann. § 5163.40 Healthy start component

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(A) The department of medicaid shall do all of the following with regard to the application procedures for the healthy start component of the medicaid program: (1) Establish a short application form for the component that requires the applicant to provide no more information than…

Ohio Rev. Code Ann. § 5163.45 Confinement of medicaid recipient in correctional facility

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(A)(1) As used in this section, subject to division (A)(2) of this section, "state or local correctional facility" means any of the following: (a) A "state correctional institution," as defined in section 2967.01 of the Revised Code; (b) A "local correctional facility," as define…

Ohio Rev. Code Ann. § 5163.50 Improving medicaid eligibility determinations and processing

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(A) The department of medicaid shall issue one or more requests for information relating to medicaid eligibility data and operations to identify and assess systems and solutions that may be available to improve or augment the management, efficiency, frequency, and accuracy of med…

Ohio Rev. Code Ann. § 5164.01 Definitions

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As used in this chapter: (A) "Adjudication" has the same meaning as in section 119.01 of the Revised Code. (B) "Behavioral health redesign" means revisions to the medicaid program's coverage of community behavioral health services beginning July 1, 2017, including revisions that …

Ohio Rev. Code Ann. § 5164.02 Rules to implement chapter

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(A) The medicaid director shall adopt rules as necessary to implement this chapter. The rules shall be adopted in accordance with Chapter 119. of the Revised Code. (B) The rules shall establish all of the following: (1) The amount, duration, and scope of the medicaid services cov…

Ohio Rev. Code Ann. § 5164.03 Mandatory and optional services

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(A) The medicaid program shall cover all mandatory services. (B) The medicaid program shall cover all of the optional services that state statutes require the medicaid program to cover. (C) The medicaid program may cover any of the optional services to which either of the followi…

Ohio Rev. Code Ann. § 5164.06 Medicaid coverage of occupational therapy services

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The medicaid program shall cover occupational therapy services provided by an occupational therapist licensed under section 4755.08 of the Revised Code. Coverage shall not be limited to services provided in a hospital or nursing facility. Any licensed occupational therapist may e…

Ohio Rev. Code Ann. § 5164.061 Chiropractic services

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(A) As used in this section: (1) "Prescriber" has the same meaning as in section 4729.01 of the Revised Code, but does not include a dentist, optometrist, or veterinarian. (2) "Prior authorization requirement" means any practice in which coverage of a health care service, device,…

Ohio Rev. Code Ann. § 5164.07 Coverage of inpatient care and follow-up care for a mother and her newborn

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(A) The medicaid program shall include coverage of inpatient care and follow-up care for a mother and her newborn as follows: (1) The medicaid program shall cover a minimum of forty-eight hours of inpatient care following a normal vaginal delivery and a minimum of ninety-six hour…

Ohio Rev. Code Ann. § 5164.071 Doula program

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(A) As used in this section, "doula" has the same meaning as in section 4723.89 of the Revised Code. (B) The medicaid program shall cover doula services that are provided by a doula if the doula has a valid provider agreement and is certified under section 4723.89 of the Revised …

Ohio Rev. Code Ann. § 5164.072 Coverage of donor breast milk and fortifiers

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(A) As used in this section, "licensed health professional" means the following: (1) A physician authorized under Chapter 4731. of the Revised Code to practice medicine and surgery or osteopathic medicine and surgery; (2) An advanced practice registered nurse who holds a current,…

Ohio Rev. Code Ann. § 5164.08 Breast cancer and cervical cancer screening

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(A) As used in this section: (1) "Screening mammography" means a radiologic examination utilized to detect unsuspected breast cancer at an early stage in asymptomatic women and includes the x-ray examination of the breast using equipment that is dedicated specifically for mammogr…

Ohio Rev. Code Ann. § 5164.09 Equivalent coverage for orally and intravenously administered cancer medications

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(A) Except as provided in division (C) of this section, the medicaid program shall cover prescribed, orally administered cancer medications on at least the same basis that it covers intraveneously administered or injected cancer medications. In implementing this section, the depa…

Ohio Rev. Code Ann. § 5164.091 Coverage for opioid analgesics

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(A) As used in this section: (1) "Benzodiazepine" has the same meaning as in section 3719.01 of the Revised Code. (2) "Chronic pain" has the same meaning as in section 4731.052 of the Revised Code. (3) "Hospice care program" and "hospice patient" have the same meanings as in sect…

Ohio Rev. Code Ann. § 5164.092 Coverage of remote ultrasounds and fetal nonstress tests

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(A) Except as provided in division (B) of this section, the medicaid program shall cover remote ultrasound procedures and remote fetal nonstress tests, utilizing established current procedural terminology codes (CPT codes) for those procedures for when the patient is in a residen…

Ohio Rev. Code Ann. § 5164.093 Coverage of rapid whole genome sequencing

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(A) As used in this section, "rapid whole genome sequencing" means an investigation of the entire human genome, including coding and non-coding regions and mitochondrial deoxyribonucleic acid, to identify disease-causing genetic changes, and includes patient-only whole genome seq…

Ohio Rev. Code Ann. § 5164.10 Coverage of tobacco cessation medications and services

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(A) The medicaid program shall cover both of the following, subject to division (C) of this section: (1) All tobacco cessation medications approved by the United States food and drug administration; (2) All forms of tobacco cessation services recommended by the United States prev…

Ohio Rev. Code Ann. § 5164.11 Use of automated review tools

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(A) As used in this section: (1) "Artificial intelligence" means a machine-based system that, for explicit or implicit objectives, infers, from the input it receives, how to generate outputs such as predictions, content, recommendations, or decisions that can influence physical o…

Ohio Rev. Code Ann. § 5164.12 Prior authorization for therapeutic behavioral services

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The department of medicaid shall impose a prior authorization requirement on all therapeutic behavioral services that are provided under the medicaid program.