Medicaid Eligibility Manual - University of Michiganmdover/website/Social... · Medicaid...

Medicaid Eligibility Manual Ted Strickland, Governor

Helen E. Jones-Kelley, Director Ohio Department of Job and Family Services

Mission: To design and maintain a user friendly Medicaid Eligibility Manual for all customers in the public and private sector.

The Electronic Publishing Unit makes every attempt to publish accurate and current information, however, we disclaim any liability or responsibility for any typographical errors, out of date information and/or other inaccuracies that may appear in this document.

eManual Contents

Please send comments to [email protected]

Recent Additions Transmittal Letters

Procedure Letters

Action Change Transmittals

Medicaid Information Letters

1 - Introduction to Medicaid General Policy

2 - Application Processing

3 -Aged, Blind, and Disabled (ABD)

4 - Covered Families and Children (CFC) 5 - Special Programs and

Services

JFS Forms Other Agency Forms

Sample Forms Desk Aids Contact Us

Recent Additions To receive eMail Notification weekly of all policy updates, subscribe to the Handbook Updates Subscription eMail by sending an eMail to: [email protected] Enter the word "subscribe" in lowercase letters in the subject line. The e-mail notification is sent every Friday afternoon which includes all new policy letters. MEMTL 44 (4/2/08) MEPL 25 (3/28/08) MEMTL 43 (3/20/08) MEMTL 42 (2/21/08) MEPL 24 (2/7/07) MEPL 23 (2/7/07) MEMTL 41 (1/1/08) MEMTL 40 (12/24/07) MEMTL 39 (12/24/07) MEPL 22 (11/19/07) MEPL 21 (10/11/07) MEPL 20 (9/6/07)

MEMTL 38 (8/15/07) MEPL 19 (8/15/07) MEMTL 37 (7/3/07)

MEM Transmittal Letters Manual Transmittal Letters (MTLs) are authored by the Medicaid Eligibility Section; they provide a summary of new, revised and/or obsolete policies or rules. MTLs are issued continuously as new regulations, policies and administrative decisions dictate. This letter introduces formal revisions to the Ohio Administrative Code rules and provides instruction of how to maintain the Medicaid Eligibility Manual.

MEMTL 44 (Children's Buy-in Program: Eligibility)

Medicaid Eligibility Manual Transmittal Letter No. 44 April 2, 2008

To: All Medicaid Eligibility Manual Holders From: Helen E. Jones-Kelley, Director Subject: Children's Buy-in Program: Eligibility

Amended Substitute House Bill 119 of the 127th General Assembly created a new program called the Children's Buy-in (CBI) Program. The CBI Program expands access to health care coverage for children in families earning more than 300% of the federal poverty level (FPL). The CBI Program is a state-funded, non-Medicaid program and is not subject to federal regulations governing Medicaid. This MEMTL contains one new rule from Chapter 5101:1-42 of the Ohio Administrative Code. This rule was adopted under the emergency provisions of division (F) of section 119.03 of the Ohio Revised Code and establishes eligibility requirements for the CBI Program. Effective Date: April 1, 2008 Chapter 5 5101:1-42-30 Children's buy-in program: eligibility This rule was adopted to establish eligibility standards for the CBI Program. The rule also defines key terms, sets forth premium amounts, and outlines individual and administrative agency responsibilities. Highlights of the rule and other procedural matters related to the CBI Program include the following:

• The CBI Program is not a county-administered program.

• All notices regarding an individual's participation in the CBI Program, including termination notices, will be electronically generated. For this reason, individuals will be required to maintain an e-mail account. Notices will not be sent by U.S. mail.

• ODJFS may suspend application or enrollment in the CBI program, and may disenroll individuals, as necessary based on available state appropriations.

• An individual interested in purchasing coverage under the CBI Program will apply online on or after April 1st using the HealthLink Information Exchange (HIEx) system. A link to HIEx will be provided on the Ohio Department of Job and Family Services (ODJFS) Office of Ohio Health Plans' (OHP) website, accessible at http://jfs.ohio.gov/ohp/cbi. A FAQ and a help desk number (866-221-7976) are available for persons requiring application assistance.

• There is no face-to-face interview for the CBI Program. Applicants will self-declare requested information during the online application process. An eligibility determination will be made by HIEx for ODJFS after all necessary information is provided.

• An individual interested in applying for CBI has an opportunity to perform a "pre-screening" before making an official application to the CBI Program. The pre-screening will indicate whether the individual meets the eligibility requirements and, if eligible, the premium amount the individual would have to pay in order to purchase health care coverage under the CBI Program.

• To be eligible to purchase health care coverage under the CBI Program, an individual must: 1. Be under nineteen years of age; 2. Be an Ohio resident and a U.S. citizen; 3. Have countable family income over 300% of the FPL (with no disregards or exemptions, except for earnings from full-time students); 4. Have been without creditable coverage (with the exception of Medicaid) for six months;

5. Not be eligible for Medicaid; and 6. Meet one of the following conditions: a) Be unable to obtain creditable coverage due to a pre-existing condition; b) Have lost the only creditable coverage available due to exhaustion of a lifetime benefit; c) The premium for the only creditable coverage available is more than two times the cost of the premium under the CBI Program; or d) Participate in the program for medically handicapped children.

• An individual must pay a premium. An individual's countable family income will determine the amount of the premium.

• Health care coverage is provided by a managed care plan (MCP) and will not begin until the first day of the month following receipt of the initial premium payment. An ID card will be issued by the MCP after the first premium payment is received.

• Failure to pay premiums for two consecutive months will result in termination of health care coverage. To resume health care coverage, the individual must reapply and pay any premium amounts past due.

• Premium payment notices will be generated by a premium collection vendor under contract with ODJFS.

• An individual must report online to HIEx any changes affecting eligibility or the premium amount. An annual redetermination may be required.

• If an individual no longer wishes to purchase coverage under the CBI Program, the individual must notify HIEx online at least thirty days prior to the desired date of discontinuation.

• An individual who disagrees with an eligibility decision may request a reconsideration by filing a written request with ODJFS within fifteen calendar days after the date of the notice.

MEM Instructions:

Location Remove Insert

Chapter 5 5101:1-42-30 (Effective 4/1/08)

This information is also available on the Internet and may be accessed at: ODJFS Electronic Manuals http://emanuals.odjfs.state.oh.us/emanuals/ InnerWeb Calendar: http://www.odjfs.state.oh.us/lpc/calendar/staff/ Internet Calendar: http://www.odjfs.state.oh.us/lpc/calendar/ HIEx: http://jfs.ohio.gov/ohp/cbi

MEMTL 43 (Medicaid Buy-In for Workers with Disabilities (MBIWD))

Medicaid Eligibility Manual Transmittal Letter No. 43 March 20, 2008

To: All Medicaid Eligibility Manual Holders From: Helen E. Jones-Kelley, Director Subject: Medicaid: Medicaid Buy-In for Workers with Disabilities (MBIWD)

Am. Sub. H.B. 119 authorized two new Medicaid eligibility groups for persons who are disabled and want to work. Medicaid Buy-in for Workers with Disabilities allows certain individuals with disabilities the opportunity to increase their earned income and resources without losing health care coverage. This Medicaid Eligibility Manual Transmittal Letter (MEMTL) contains rule 5101:1-41-30 of the Administrative Code, "Medicaid buy-in for workers with disabilities (MBIWD)" as well as form JFS 07211, "Medicaid Buy-In for Workers with Disabilities (MBIWD) Addendum". Effective date: April 1, 2008 Chapter 5 5101:1-41-30 Medicaid: Medicaid Buy-In for Workers with Disabilities (MBIWD) Rule 5101:1-41-30 of the Administrative Code implements two new Medicaid eligibility groups: (1) MBIWD basic coverage group and (2) MBIWD medically improved coverage group. Individuals in these two coverage groups are considered a group of one for purposes of determining or redetermining eligibility. The key factors for MBIWD eligibility are as follows: Individuals eligible for the MBIWD basic coverage group must:

• Meet the citizenship requirements outlined in rule 5101:1-38-02.3 of the Administrative Code; • Be a resident of Ohio;

• Be at least sixteen and less than sixty-five years of age;

• Be disabled as defined by the Social Security Administration (SSA) for purposes of the federal Supplemental Security Income program (SSI), except employment activity, earnings, and substantial gainful activity must not be considered when determining disability for MBIWD;

• Have countable income (after disregards) and countable resources within specified limits;

• Pay a premium, if applicable; and,

• Be working. Individuals eligible for the MBIWD medically improved group must:

• Have been eligible for the MBIWD basic coverage group in the previous calendar month, and continue to meet all eligibility criteria except the disability criterion; and

• Be working at least forty hours per month earning at least the state or federal minimum wage, whichever is lower.

The MBIWD program considers only an individual's own resources. If resources are jointly owned, determine the value of the individual's countable resources under rules 5101:1-39-05 and 5101:1-39-26. To be resource-eligible for the MBIWD program, an individual must have no more than $10,000 in countable resources. CRISE should correctly calculate an MBIWD individual's income. To be eligible for the MBIWD program, a consumer's income (after the relevant disregards) must not exceed 250% of the Federal Poverty Level (FPL) for one person. The exemptions and disregards in rule 5101:1-39-18 do apply in the MBIWD program, but in a slightly different order. If the resulting income after the applicable disregards in rule 5101:1-39-18 exceeds 250% FPL for one person, an additional deduction is taken from earned income each month to bring the individual's income down to 250% FPL. This additional

deduction is limited to $20,000 per year, can only be taken from earned income, and can be deducted from previous earnings if retroactive eligibility is being explored. Once an additional $20,000 in a year (beginning from the first month of eligibility) has been disregarded, unless the individual reports a drop in income, the individual will be over income for the MBIWD program until a year (from the first month of eligibility) has passed and the consumer is eligible for a new $20,000 annual earned income disregard. Calculating the premium (and determining whether the individual must pay a premium) involves several financial calculations. A premium calculator will be available on the innerweb. Eligibility for the MBIWD program (whether it is prospective or retroactive eligibility) begins no earlier than the program's April 1, 2008, start date. Forms JFS 07211 Medicaid Buy-In for Workers with Disabilities (MBIWD) Addendum The MBIWD addendum form, JFS 07211, is designed to be used with the JFS 07200 "Request for Cash, Food Stamp, and Medical Assistance" application. The addendum should be accepted and processed on or after April 1, 2008. The JFS 07211 is not an application for cash assistance, regular Medicaid, food stamps, or waiver assistance. The JFS 07211 may be used for mail-in or face-to-face interviews for MBIWD. A face-to-face interview is optional, at the consumer's request, but should never be required by the CDJFS. Applications for MBIWD should be processed in accordance with OAC 5101:1-38-01.2 and 5101:1-41-30. There is no potential for eligibility before the program's April 1, 2008, start date. MEM Instructions:

Location Remove Replace

Chapter 5 n/a 5101:1-41-30 (Effective 4/1/08)

JFS Forms n/a JFS 07211 (02/2008)

This information is also available on the Internet and may be accessed at: ODJFS Electronic Manuals http://emanualstest.odjfs.state.oh.us/emanuals/ InnerWeb Calendar: http://www.odjfs.state.oh.us/lpc/calendar/staff/ Internet Calendar: http://www.odjfs.state.oh.us/lpc/calendar/

MEMTL 42 (Medicaid: Standards of Need) Medicaid Eligibility Manual Transmittal Letter No. 42

February 21, 2008

To: All Medicaid Eligibility Manual Holders From: Helen E. Jones-Kelley, Director Subject: Medicaid: Standards of Need

Am. Sub. H.B. 119 expanded coverage for pregnant women from 150% to 200% of the federal poverty level (FPL) for her family size and removed the 24-month clock on low income family (LIF) budgeting. Those changes were accomplished through revisions of rules contained in MEMTL's 39 and 40. Rule 5101:1-40-26 is being revised to more clearly reflect the standards in rules 5101:1-40-08 and 5101:1-40-25. This rule was reviewed in accordance with section 119.032 of the Revised Code. Effective date: March 1, 2008 Chapter 4 5101:1-40-26 Medicaid: standards of need This rule is being amended to state that the standards for LIF Medicaid are set out in rule 5101:1-40-25 and that, as set out in rule 5101:1-40-08, if a pregnant woman has income between 150% and 200% of the FPL for her family size, then the income will be disregarded in the amount of the difference between 150% and 200% of the FPL for her family size when determining eligibility as a pregnant woman. MEM Instructions:


Chapter 4 5101:1-40-26 (Effective 1/1/06) 5101:1-40-26 (Effective 3/1/08)

This information is also available on the Internet and may be accessed at: ODJFS Electronic Manuals http://emanuals.odjfs.state.oh.us/emanuals/ InnerWeb Calendar: http://www.odjfs.state.oh.us/lpc/calendar/staff/ Internet Calendar: http://www.odjfs.state.oh.us/lpc/calendar/

MEMTL 41 (Medicaid: Children in Care and Individuals Younger than Age Twenty-One Who Have Aged Out of Foster Care)

Medicaid Eligibility Manual Transmittal Letter No. 41 Family, Children And Adult Services Procedure Letter No. 134

January 1, 2008

To: Medicaid Eligibility Manual Holders Family, Children and Adult Services Manual Holders

From: Helen E. Jones-Kelley, Director Subject: Medicaid: Children in Care and Individuals Younger than Age Twenty-one Who Have

Aged Out of Foster Care.

House Bill 119 of the 127th General Assembly establishes that youth who have aged out of foster care and meet all eligibility requirements are eligible for Medicaid until they reach age twenty-one. This rule was reviewed in accordance with section 119.032 of the Revised Code. This Letter contains rule 5101:1-40-03 of the Administrative Code, "Medicaid: children in care and individuals younger than age twenty-one who have aged out of foster care" which is now the rule for all children in care and includes the Medicaid expansion for aged out foster care youth to age twenty-one. Also included are rescinded rules 5101:1-40-03 "Covered families and children (CFC) medicaid: children in care", 5101:1-40-02.3 "Covered families and children medicaid: coverage for foster care maintenance and adoption assistance money payment recipients", and 5101:1-40-10 "Covered families and children Medicaid: county case responsibility for individuals in custody of public children services and private child placing agencies". Attached is the revised form JFS 01958 "Referral for Medicaid Continuing Eligibility Review". The effective date is January 1, 2008. Chapter 4 of the Medicaid Eligibility Manual 5101:1-40-03 Medicaid: children in care and individuals younger than age twenty-one who have aged out of foster care. This rule is changed to reflect the expanded coverage for youth aging out of foster care. Youth must be in foster care at age 18 and must have received Title IV-E services before age 18. There is no resource or income test, and no face to face interview is required. PCSA staff must use the JFS 01958 "Referral for Medicaid Continuing Eligibility Review" to provide information to the CDJFS in order to explore eligibility for this new category. MEM/FCASM Instructions:


Chapter 4 5101:1-40-03 (Effective August 30, 2002)

5101:1-40-03 (Effective January 1, 2008)

5101:1-40-2.3 (Effective February 1, 2000)

5101:1-40-10 (Effective July 1, 2000)

Procedure Letters FCASPL 134

JFS Forms JFS 01958 (6/2003) JFS 01958 Rev. (12/2007)

ODJFS Electronic Manuals http://emanuals.odjfs.state.oh.us/emanuals/ InnerWeb Calendar: http://www.odjfs.state.oh.us/lpc/calendar/staff/ Internet Calendar: http://www.odjfs.state.oh.us/lpc/calendar/

MEMTL 40 (Coverage for Children and Pregnant Women)

Medicaid Eligibility Manual Transmittal Letter No. 40 December 24, 2007

To: All Medicaid Eligibility Manual Holders From: Helen E. Jones-Kelley, Director Subject: Medicaid: Coverage for Children and Pregnant Women

Am. Sub. H.B. 119 expanded coverage for pregnant women from 150% to 200% of the federal poverty level (FPL) for her family size. Rule 5101:1-40-08 is being rescinded and replaced in order to reflect this change. This rule was reviewed in accordance with section 119.032 of the Revised Code. Effective date: January 1, 2008 Chapter 4 5101:1-40-08 Medicaid: coverage for children and pregnant women This rule is being changed to raise the income limit for a pregnant woman to 200% of the FPL for her family size. The entire rule has been rewritten for clarity, and "creditable coverage" has been defined (for children with family income over 150% of FPL). No other substantive changes have been made to eligibility for pregnant women or children with family income up to 200% of FPL. MEM Instructions:




MEMTL 39 (Medicaid: Low Income Families)


To: All Medicaid Eligibility Manual Holders From: Helen E. Jones-Kelley, Director Subject: Medicaid: Low Income Families

Am. Sub. H.B. 119 removed the 24-month time limit on eligibility for low income families (LIF) Medicaid for parents with family income of no more than 90% of the federal poverty level (FPL). Rule 5101:1-40-05 is being amended, and rule 5101:1-40-25 is being rescinded and replaced in order to reflect this change. These rules were reviewed in accordance with section 119.032 of the Revised Code. Effective date: January 1, 2008 Chapter 4 5101:1-40-05 Medicaid: transitional medicaid This rule is being amended to reflect the fact that low income families will no longer be subject to a 24-month limit, and therefore will not become eligible for transitional Medicaid as a result of time-limited budgeting. Some definitions have also been added to the rule. 5101:1-40-25 Covered families and children medicaid: low income families (LIF) This rule is being changed to reflect the removal of the 24-month time limit for LIF Medicaid. The two-step budgeting process has not changed, except that there is no longer a time limit on how long an individual can be eligible when a family's gross nonexempt income is no more than 90% FPL. To be Medicaid-eligible under this rule, an individual must be the parent of and residing with a child; a child's eligibility is determined under other Medicaid rules, including rule 5101:1-40-08 "Medicaid: coverage for children and pregnant women". MEM Instructions:



5101:1-40-25 (Effective 1/1/06) 5101:1-40-25 (Effective 1/1/08)


MEMTL 38 (Medicaid: Qualified Long-Term Care Partnership and Estate Recovery)

Medicaid Eligibility Manual Transmittal Letter No. 38 August 15, 2007

To: All Medicaid Eligibility Manual Holders From: Helen E. Jones-Kelley, Director Subject: Medicaid: Qualified Long-Term Care Partnership and Estate Recovery

This Medicaid Eligibility Manual Transmittal Letter contains rule 5101:1-38-10 of the Administrative Code, "Medicaid Estate Recovery." This new rule, reviewed in accordance with section 119.032 of the Revised Code, replaces rule 5101:1-38-10 of the Administrative Code. This MEMTL also contains rule 5101:1-38-11, "Medicaid: Treatment of Qualified Long-Term Care Insurance Policies" and amended rule 5101:1-39-31, "Medicaid: Treatment of the Home." Effective date: September 1, 2007 Chapter 2 Medicaid estate recovery 5101:1-38-10 This rule is rescinded and made new to reflect the implementation of changes in O.R.C. section 5111.11. The Revised Code expanded the population subject to Medicaid estate recovery to include individuals who are permanently institutionalized (in a nursing or medical institution, not receiving community-based Medicaid). The assets subject to recovery have also been broadened to include non-probate assets. An Undue Hardship Waiver process has been created and identified in the rule. The rule also includes new provisions related to the Qualified Long Term Care Partnership. Medicaid: qualified long term care partnership 5101:1-38-11 This new rule defines the QLTCP program under O.R.C. section 5111.18. To be a "Partnership policy," a long term care policy must meet specific criteria: the Ohio Department of Insurance has the responsibility of determining whether a policy meets those criteria. A consumer with a Partnership policy receives a resource disregard ("QLTCP disregard") -- after a resource assessment and allocation -- equal to the amount of the benefits that have been paid to date by the Partnership policy to or on behalf of that consumer. This QLTCP disregard may also be applied to transferred resources that might otherwise trigger a Restricted Medicaid Coverage Period. However, the total QLTCP disregard applied can never exceed the total amount of benefits actually paid by the Partnership policy to or on behalf of the consumer. Chapter 3 Medicaid: treatment of the home 5101:1-39-31 This rule has been amended to clarify that a QLTCP disregard cannot be used to offset or reduce the home equity restriction in paragraph (C)(5) of this rule. MEM Instructions:

Location Remove Replace With

Chapter 2 5101:1-38-10 (effective 7/1/2000) 5101:1-38-10 (effective 9/1/2007)

n/a 5101:1-38-11 (effective 9/1/2007)


This information is also available on the Internet and may be accessed at: ODJFS Electronic Manuals

http://emanuals.odjfs.state.oh.us/emanuals/ InnerWeb Calendar: http://www.odjfs.state.oh.us/lpc/calendar/staff/ Internet Calendar: http://www.odjfs.state.oh.us/lpc/calendar/

MEMTL 37 (5101:1-38-02 Medicaid: Verification and Reporting Requirements)

Medicaid Eligibility Manual Transmittal Letter No. 37 July 3, 2007

To: All Medicaid Eligibility Manual Holders From: Helen E. Jones-Kelley, Director Subject: 5101:1-38-02 Medicaid: Verification and Reporting Requirements

This Medicaid Eligibility Manual Transmittal Letter amends rule 5101:1-38-02 of the Administrative Code to include additional groups excluded from the citizenship verification and reporting requirement and to clarify this requirement for newborns. Chapter 2 Medicaid: Verification and Reporting Requirements 5101:1-38-02 The Deficit Reduction Act of 2005 required verification of U.S. citizenship for all applicants and recipients of Medicaid except for those individuals already enrolled in Medicare or receiving SSI. Amended federal legislation now requires that we exclude additional groups from the citizenship verification requirement. Effective 9/25/2006, individuals receiving foster care or adoption assistance under Title IV-E, those in foster care receiving child welfare services under Title IV-B, and those receiving Social Security Disability Insurance (SSDI) are also excluded from this requirement. Clarification of the citizenship verification and reporting requirement as it pertains to newborns has also been added to the rule. MEM Instructions:

Location Remove Replace With


MEPLs MEPL 14 (effective 1/26/2007) N/A


MEMTL 36 (Medicaid: Voter Registration Requirements)

Medicaid Eligibility Manual Transmittal Letter No. 36 May 18, 2007

To: All Medicaid Eligibility Manual Holders From: Helen E. Jones-Kelley, Director Subject: Medicaid: Voter Registration Requirements

This Medicaid Eligibility Manual Transmittal Letter (MEMTL) amends rule 5101:1-38-01.2 of the Administrative Code. This proposed change will direct CDJFS' to the voter registration process maintained in rule 5101:1-2-15 of the Administrative Code, as required by section 3503.10 of the Revised Code and by the National Voter Registration Act of 1993. Also, the amended rule refers the CDJFS to section 5111.11 of the Revised Code. As amended, this rule is not subject to a five-year rule review. The effective date of this rule is June 1, 2007. Chapter 2 Medicaid: 5101:1-38-01.2 Application Processing. The amended rule references voter registration requirements outlined in the Office of Family Stability's voter registration requirements rule. Specifically, rule 5101:1-38-01.2 of the Administrative Code is amended at paragraph (C)(6)(b)(xxii) to reference rule 5101:1-2-15 of the Administrative Code. Also, other changes in paragraph (C) include correcting four revision dates on forms. In addition to the revision date changes, the JFS 07400 "Ohio Medicaid Estate Recovery" form, revised June 2007, modifies estate recovery language to comply with changes made to estate recovery by Substitute Amended House Bill 66. MEM Instructions:


Chapter 2 5101:1-38-01.2 (effective 10/1/06)

5101:1-38-01.2 (effective 6/1/07)

JFS Forms JFS 07400 (rev. 5/2005) JFS 07400 (rev. 6/2007)


MEMTL 35 (Medicaid: Deficit Reduction Act of 2005)

Medicaid Eligibility Manual Transmittal Letter No. 35 November 13, 2006

To: All Medicaid Eligibility Manual Holders From: Barbara E. Riley, Director Subject: Medicaid: Deficit Reduction Act of 2005

The Ohio Department of Job and Family Services (ODJFS) reviewed this rule in accordance with Section 119.032 of the Ohio Revised Code (ORC). Rule 5101:1-39-24 of the Ohio Administrative Code (OAC) is rescinded under Section 119.03 of the ORC and the new rule is promulgated under 111.15. This MEMTL contains one rule from Chapter 5101:1-39 of the OAC. The new rule clarifies the federal budget requirements contained in the Deficit Reduction Act of 2005. The effective date of this MEMTL is December 1, 2006. Chapter 3 5101:1-39-24 Medicaid: Determining patient liability. This rule is rescinded and made new to define the treatment of income in determining patient liability for individuals receiving long-term care (LTC) services in a LTC facility, under an HCBS waiver, or under PACE. This rule requires an income-first approach before allocating additional resources to the community spouse. All available income of the institutionalized spouse must be considered before allocating additional resources to the community spouse. Significant changes to this rule include:

• A reformatted definition for the Minimum Monthly Maintenance Needs Allowance (MMMNA), in paragraph (B);

• Clarification regarding the treatment of veteran's reduced pension, in paragraph (C);

• Clarification to the Monthly Income Allowance (MIA) calculation, in paragraph (C)(2)(d);

• Clarification regarding the treatment of a Personal Needs Allowance (PNA) when determining patient liability (C)(2)(c); and

• An exclusion of the date of death or date of discharge from the prorated payment calculation in paragraph (C)(2)(i)(ii).

The following forms are revised and effective October 1, 2006: JFS 04078 "Monthly Income Allowance Computation Worksheet" (Revised 10/06) The CDJFS completes this worksheet when determining the amount of income the community spouse is entitled to receive from the institutionalized spouse as a monthly income allowance; the worksheet is then provided to the consumer. This form has also been reformatted for clarity. JFS 07332 "Notice of Denial of Your Application for Medicaid in Cases Involving a Community Spouse" (Revised 10/06) Language has been added to inform the consumer about requesting a state hearing when there is a need for a reallocation of the couple's resources due to insufficient income to generate the full amount of the monthly income allowance. The following form is new and effective October 1, 2006: JFS 07139 "Medicaid APPROVAL Notice in Cases with A Community Spouse" (10/06) The CDJFS uses this form to notify the consumer of the approval of a Medicaid application for LTC services. This form is used along with the JFS 04076, JFS 04077, and JFS 04206, as appropriate. Desk aids and presentations are available in the eManual Contents section of the Medicaid Eligibility Manual (MEM). MEM Instructions:


Chapter 3 5101:1-39-24 (Effective July 1, 2005)

5101:1-39-24 (December 1, 2006)

Appendix/ JFS Forms

JFS 04078 (Rev.03/2003) JFS 04078 (Rev. 10/2006)

Not Applicable JFS 07139 (Rev. 10/2006)

JFS 07332 (Rev. 05/2001) JFS 07332 (Rev. 10/2006)

This information is also available on the Internet and may be accessed at: ODJFS Electronic Manuals: http://emanuals.odjfs.state.oh.us/emanuals ODJFS Forms Central: http://www.odjfs.state.oh.us/forms/inter.asp InnerWeb Calendar: http://www.odjfs.state.oh.us/lpc/calendar/staff/ Internet Calendar: http://www.odjfs.state.oh.us/lpc/calendar/

MEMTL 34 (Medicaid: Transfer of Resources Forms)

Medicaid Eligibility Manual Transmittal Letter No. 34 October 17, 2006

To: All Medicaid Eligibility Manual Holders From: Barbara E. Riley, Director Subject: Medicaid: Transfer of Resources Forms

The Ohio Department of Job and Family Services (ODJFS) reviewed these rules in accordance with Section 119.032 of the Ohio Revised Code (ORC). The new rule sets forth the federal budget requirements contained in the Deficit Reduction Act of 2005. This MEMTL contains one rule from Chapter 5101:1-39 of the Ohio Administrative Code (OAC) and seven forms. The effective date of the rule is October 20, 2006. The effective date of the forms is October 1, 2006. Chapter 2 Application Processing The following optional forms are new. JFS 07111 "Notice of New Citizenship Requirement for Medicaid" (10/06) This form is optional and the CDJFS can use this form to notify the consumer that due to a change in their case information, the CDJFS now needs the consumer to provide proof of U.S. citizenship. JFS 07405 "Third Party Affidavit of Birthplace or Nationality" (10/06) This form is optional and the CDJFS can use this form to be completed by at least two individuals who have personal knowledge of the event(s) establishing the applicant/recipient's claim of U.S. citizenship. JFS 07407 "Affidavit of Identity for a Child Age 16 Years or Less" (10/06) This form is optional and the CDJFS can use this form to be completed by the parent/guardian for a child age 16 years or less as identity documentation of the child. Chapter 3 Aged, Blind, and Disabled (ABD) 5101:1-39-07 Medicaid: Transfer of Resources This rule is new and replaces 5101:1-39-07 Medicaid: transfer of resources which defines the treatment of a transfer of resources. The rule format was revised to be consistent with other new rules in the Medicaid Eligibility Manual (MEM). Other revisions include:

• Language extending the look-back period to sixty months.

• For improper transfers made on or after February 8, 2006, restricted Medicaid coverage period begins on the first day of the month during or after which assets were transferred for less than fair market value, or the date the individual is eligible for medical assistance and would otherwise be receiving LTC services in a LTC facility, HCBS waiver, or PACE, whichever is later.

• For improper transfers made on or after February 8, 2006, language has been added to calculate the restricted Medicaid coverage period. This rule includes new language which prohibits rounding down or disregarding any fractional restricted Medicaid coverage periods.

• Language has been added to clarify the undue hardship process and to give the facility the authority to request an undue hardship for the resident.

• The CDJFS is responsible to notify the individual of the undue hardship and of the decision to grant an undue hardship exception.

• Undue hardship does not permit an individual to receive LTC services while the hardship decision is pending.

• The individual and the nursing facility must exhaust all legal remedies to compel the return of the asset before the individual can qualify for an undue hardship.

The following forms are new and effective October 1, 2006. JFS 04027 "Restricted Medicaid Coverage Period Determination" (10/06) The CDJFS uses this budgeting worksheet to provide the consumer with information regarding the determination of the period of time an institutionalized individual is subject to a restricted Medicaid coverage period due to an improper transfer of resources. This form provides a budget method for improper transfers that occurred on or after February 8, 2006. JFS 07138 "Notice of Approval of Your Application for Medicaid with Restricted Coverage" (10/06) Additional language is added regarding the five hundred thousand dollar home equity disqualification for coverage of LTC services. Undue hardship language has also been added. JFS 07140 "Availability of Hardship Exemption" (10/06) The CDJFS sends this notice to the consumer detailing the right to request a hardship exemption when a determination has been made that the individual is not eligible for LTC services due to either an improper transfer of resources or home equity in excess of five hundred thousand dollars. A hardship may occur if the imposition of a restricted coverage period would deprive the consumer of medical care such that the individual's health or life would be endangered. JFS 07141 "Decision on Your Request for a Hardship Exemption" (10/06) The CDJFS uses this form to notify the consumer of the decision made on their request for a hardship exemption. Hearing rights are also included on the form. MEM Instructions:


Chapter 2 Not Applicable JFS 07111 (Rev. 10/2006)



Chapter 3 5101:1-39-07 November 7, 2002 5101:1-39-07 October 20, 2006





This information is also available on the Internet and may be accessed at: ODJFS Electronic Manuals http://emanualstest.odjfs.state.oh.us/emanuals/ ODJFS Forms Central: http://www.odjfs.state.oh.us/forms/inter.asp Inner Web Calendar: http://www.odjfs.state.oh.us/lpc/calendar/staff/

Internet Calendar: http://www.odjfs.state.oh.us/lpc/calendar/

MEMTL 33 (Medicaid: Deficit Reduction Act of 2005)


To: All Medicaid Eligibility Manual Holders From: Barbara E. Riley, Director Subject: Medicaid: Deficit Reduction Act of 2005

The Ohio Department of Job and Family Services (ODJFS) reviewed these rules in accordance with Section 119.032 of the Ohio Revised Code (ORC). The new and amended rules sets forth the federal budget requirements contained in the Deficit Reduction Act of 2005 and state budget requirements contained in Amended Substitute House Bill 66. This MEMTL contains eighteen rules: one rule from Chapter 5101:1-38 of the Ohio Administrative Code (OAC); sixteen rules from Chapter 5101:1-39 of the OAC; and, one rule from Chapter 5101:1-41 of the OAC. The effective date of this MEMTL is October 1, 2006. Chapter 2 5101:1-38-01.2 Medicaid: Application process. This rule is new and replaces 5101:1-38-01.2 Medicaid: application process to add annuity disclosure language requiring Medicaid applicants and some recipients of long term care (LTC) services, a home and community-based services (HCBS) waiver, or the program of all inclusive care for the elderly (PACE) to name the State of Ohio remainder beneficiary of the annuity. Additional changes to the rule include the following:

• References to the JFS 07100 "Application for Income, Medical, and Food Assistance" (also known as the "common application form" (CAF)) have been removed.

• 19 and 20 year olds can now use the JFS 07216 "Combined Programs Application" (CPA) to apply for Medicaid. Also, a face-to-face interview is no longer required for 19 and 20 year olds.

• A face-to-face interview must be scheduled within 10 days of the receipt of an application for medical assistance.

• A legal entity can be an authorized representative. Also, the administrative agency may request proper identification from the authorized representative.

• Individuals who knowingly make or cause a false or misleading statement to be made, conceal an interest in property, or fail to disclose a transfer of property may be guilty of Medicaid eligibility fraud.

• Reorganizing and formatting for clarification. References to automated systems have been removed.

Chapter 3 5101:1-39-02.2 Medicaid: Continuing care communities, life care communities and philanthropic long-term care facilities. This rule is new and replaces 5101:1-39-0.2 Medicaid: aged, blind or disabled philanthropic long-term care facility medicaid assistance groups to include language regarding the treatment of entrance fees as countable resources for individuals residing in continuing care retirement communities and life care communities. 5101:1-39-05 Medicaid: Resource requirement. This rule is new and replaces 5101:1-39-05 Medicaid: resource requirement to include language regarding the treatment of entrance fees as countable resources for individuals residing in continuing care retirement communities and life care communities, as outlined in OAC rule 5101:1-39-02.2.

5101:1-39-08 Medicaid: Income. This rule is new and replaces 5101:1-39-08 Medicaid: income to add definitions, formatting revisions, and language clarifications. Additional changes include:

• Adding clarification that deductions due to a repayment of an overpayment, loan or other debt is not considered income if the amount being withheld was included when determining the amount of unearned income for a previous month.

• In the determination of medical assistance eligibility, court-ordered deductions are still considered as income to the individual.

• Child support payments made to an individual on behalf of an adult child is not considered income unless the individual retains the income and does not give it to the adult child.

• Liens are not an allowable deduction from income. 5101:1-39-22.7 Medicaid: Retirement and income supplementing accounts (RISAs). This rule is amended to include a reference to the annuity requirements as outlined in OAC rule 5101:1-39-22.8. 5101:1-39-22.8 Medicaid: The disclosure and treatment of annuities for recipients or applicants for long term care services. This rule is new and replaces 5101:1-39-22.8 Medicaid: annuities to specify the annuity disclosure requirements and remainder beneficiary designations for any annuity purchased by individuals applying for LTC services, HCBS waivers, or PACE. The State must be named as the remainder beneficiary in the first position, or in the second position after the spouse or minor child or disabled child of any age. This rule also addresses the purchase of an annuity with funds from a retirement account (i.e. RISA). The purchase of an annuity will be considered an improper transfer unless the purchase meets specific criteria as outlined in this rule. This rule also provides guidance for annuities purchased prior to February 8, 2006. The life expectancy tables have been removed from the rule. 5101: 1-39-26 Medicaid: Resource exemptions. This rule is new and replaces 5101:1-39-26 Medicaid: resource exemptions to include new language referring to the principal place of residence in OAC rule 5101:1-39-31. The following exempt resources not previously listed in the rule have been added:

• Certain prepaid burial contracts.

• Interest in trust or restricted lands if the individual or spouse is of Native American Indian descent.

• Assistance received as a result of a catastrophe declared by the President of the United States as a major disaster, victims of crime funds, or relocation assistance.

• Grants, scholarships and gifts used to pay tuition, fees and other necessary educational expenses.

• Funds received from the Ricky Ray Hemophilia Relief fund. Language has also been added to address interest earned on different types of funds and how this interest affects eligibility. Other changes include formatting and the addition of definitions of terms. 5101:1-39-27.1 Medicaid: Trusts. This rule is new and replaces 5101:1-39-27.1 Medicaid: trusts to include language defining the treatment of trusts for the purpose of determining eligibility for medical assistance programs. The look-back period for all trusts is extended to 60 months. 5101:1-39-27.3 Medicaid: Promissory notes, mortgages, stocks, bonds and loans. This rule is new and replaces 5101:1-39-27.3 Medicaid: promissory note, mortgages, stocks and bonds to address the treatment of funds used to purchase promissory notes, mortgages, and loans as assets. Funds used to purchase these items may be considered an improper transfer of assets unless the items have a repayment term that is actuarially sound, provides for payments in equal

amounts with no deferrals or balloon payments, and prohibits the cancellation of the balance upon the lender's death. These items are still considered an available asset when determining eligibility for medical assistance. 5101:1-39-30 Medicaid: Life insurance. This rule is new and replaces 5101:1-39-30 Medicaid: life insurance to include a reference to the annuity requirements as outlined in OAC rule 5101:1-39-22.8. Additional formatting changes are added and definitions are revised. The cash surrender value table has been removed from the rule. 5101:1-39-31 Medicaid: Treatment of the home. This new rule combines rescinded OAC rules 5101:1-39-31.1 and 5101:1-39-31.2. This rule specifies that an individual with home equity interest in excess of five hundred thousand dollars is not eligible for LTC services, HCBS waivers, or PACE; however, the individual may still be eligible for Medicaid. Exceptions to the five hundred thousand dollar home equity disqualification are listed in this rule. The home equity limit applies to individuals:

• Applying for Medicaid and LTC services, HCBS waivers or PACE on or after January 1, 2006.

• In receipt of Medicaid prior to January 1, 2006, who apply for LTC services, HCBS waiver, or PACE on or after January 1, 2006.

• In receipt of Medicaid and LTC services, HCBS waivers or PACE prior to January 1, 2006, who have had a break in LTC services, HCBS waivers or PACE on or after January 1, 2006.

Information on the availability of an undue hardship exemption has been added. As a result of Amended Substitute House Bill 66, the homestead property exemption is extended from six to thirteen months for individuals residing in a nursing facility. The homestead exemption begins when the individual is institutionalized and is eligible for Medicaid. 5101: 1-39-31.1 Medicaid: Home as principal place of residence. This rule is rescinded and the language in this rescinded rule is incorporated into OAC rule 5101:1-39-31. 5101:1-39-31.2 Medicaid: Property no longer the principal place of residence. This rule is rescinded and the language in this rescinded rule is incorporated into OAC rule 5101:1-39-31. 5101:1-39-32 Medicaid: Life estates and life leases as resources. This rule is new and replaces 5101:1-29-32 Medicaid: life estates and life leases to add language regarding the purchase of a life estate interest in another individual's home. The purchase of a life estate interest in another individual's home may result in the determination of an improper transfer of assets if the individual does not reside in the home in which he or she owns the life estate for at least 12 months. The individual must also purchase the life estate for fair market value. The life estate may also be considered an available resource. Additional formatting changes are added and definitions are revised. 5101:1-39-32.1 Medicaid: Property agreements. This rule is amended to add definitions of terms used in the rule. 5101: 1-39-35 Medicaid: Resource assessment. This rule is new and replaces 5101:1-39-35 Medicaid: resource assessment to clarify when a resource assessment must be completed. Changes to the rule include:

• Completing a resource assessment based on the date of marriage if an institutionalized individual marries someone in the community.

• Completing one resource assessment based on each spouse's first continuous period of institutionalization when either spouse is institutionalized.

• Accepting the date of the first continuous period of institutionalization that occurred out of state, but completing new resource assessment to determine if the individual is eligible under the OAC.

• Formatting and the addition of definitions of terms used in the rule. 5101:1-39-36.1 Medicaid: Resource budgeting methodology for institutionalized individuals with a spouse in the community. This rule is new and replaces 5101:1-39-36.1 Medicaid: resource budgeting method for institutionalized individuals with a spouse in the community to add language requiring that all available income of the institutionalized spouse must be allocated to the community spouse (income-first) before additional resources can be transferred to the community spouse through the state hearing process. Chapter 5 5101:1-41-05 Breast and cervical cancer project (BCCP) Medicaid: Application and eligibility determination process. This rule is amended to rescind the appendix containing the JFS 07161 "Ohio Breast and Cervical Cancer Project (BCCP) Medicaid Application". The form is available through the ODJFS Forms Central website. The following form is revised and effective October 1, 2006: JFS 04077 "Resource Transfer Worksheet" (Revised 10/06) This worksheet is used by the county department of job and family services (CDJFS) to determine the amount of resources the community spouse is entitled to retain when spousal impoverishment provisions apply. The form has been reformatted for clarity. The following form is new and effective October 1, 2006: JFS 04206 "Family Allowance (FA) and Family Maintenance Needs Allowance (FMNA) Computation Worksheet" (10/06) The CDJFS uses this budgeting worksheet to provide the consumer with information regarding the determination of the family allowance and family maintenance needs allowance. This form is used along with the JFS 07332 or JFS 07139, as appropriate. The following forms are made obsolete: JFS 04079 "Determination of Income and Resources Allocation" (Revised 03/03) The information on this form has been incorporated into the JFS 07138 and JFS 07139. JFS 07135 "Medicaid Long Term Care Facility Information Worksheet" (Revised 01/90) This form was created to obtain information for the period January 1, 1990 through December 31, 1990. Desk aids and presentations are available in the eManual Contents section of the Medicaid Eligibility Manual (MEM). MEM Instructions:


Chapter 2 5101:1-38-01.2 (Effective June 1, 2003)

5101:1-38-01.2 (Effective October 1, 2006)

Chapter 3 5101:1-39-02.2 (Effective October 1, 2002)


5101:1-39-05 (Effective July 1, 2005)

5101:1-39-05 (Effective October 1, 2006)

5101:1-39-08 (Effective July 1, 2005)


5101:1-39-22.7 (Effective December 1, 2004)


5101:1-39-22.8 (Effective November 7, 2002)


5101:1-39-26 (Effective May 1, 1998)








Not Applicable 5101:1-39-31 (Effective October 1, 2006)


Not Applicable


Not Applicable

5101:1-39-32 (Effective November 7, 2002)




5101:1-39-35 (Effective July 1, 2005)


5101:1-39-36.1 (Effective July 1, 2003)




Appendix/ JFS Forms

JFS 04077 (Rev. 04/2004) JFS 04077 (Rev. 10/2006)

JFS 04079 (Rev. 03/2003) Not Applicable


JFS 07135 (Rev. 01/1990) Not Applicable

This information is also available on the Internet and may be accessed at: ODJFS Electronic Manuals: http://emanuals.odjfs.state.oh.us/emanuals ODJFS Forms Central: http://www.odjfs.state.oh.us/forms/inter.asp

InnerWeb Calendar: http://www.odjfs.state.oh.us/lpc/calendar/staff/ Internet Calendar: http://www.odjfs.state.oh.us/lpc/calendar/

MEMTL 32 (Medicaid: Verification Requirements)

Medicaid Eligibility Manual Transmittal Letter No. 32 September 28, 2006

To: All Medicaid Eligibility Manual Holders From: Barbara E. Riley, Director Subject: Medicaid: Verification Requirements

The Deficit Reduction Act (DRA) of 2005 imposes specific verification requirements on applicants for and recipients of Medicaid. The new verification responsibilities are:

• U.S. citizenship.

• Changes to annuities. This rule was reviewed in accordance with section 119.032 of the Revised Code. The effective date of the rule is September 25, 2006. Chapter 2 5101:1-38-02 Medicaid: Verification and Reporting Requirements. Rule 5101:1-38-02 of the Administrative Code is a new rule that replaces rule 5101:1-38-02 of the Administrative Code. The new rule outlines the verification and reporting requirements for Medicaid, and includes:

• Requirements for verification of U.S. citizenship. Individuals declaring U.S. citizenship must provide either a citizenship document or a combination of a birth/nationality document and an identity document. A hierarchy of acceptable documents is included in the rule.

• A reasonable opportunity period for individuals to obtain the necessary verifications. The administrative agency must assist individuals in securing the verifications needed in establishing eligibility. Good cause language is added to establish criteria when an individual has not cooperated with providing verifications.

• The administrative agency's responsibility in recording the receipt of the documents in the case file and retaining copies.

• Individuals having an ownership interest in an annuity must identify any changes made to that annuity, including a transaction such as a change in beneficiary.

The following forms have been revised effective October 1, 2006: JFS 07161 "Ohio Breast & Cervical Cancer Project Medicaid Application" (Revised 10/2006) This application is used by the consumer when applying for Breast and Cervical Cancer Medicaid through the Ohio Department of Health. The application is revised to ask whether the applicant is a U.S. citizen. The Rights and Responsibilities page is revised to add information about the requirement to provide proof of U.S. citizenship. JFS 07216 "Healthy Start/Healthy Families Combined Programs Application" (Revised 10/2006) This application is used to apply for Healthy Start/Healthy Families Medicaid along with other programs. The application is revised to add information on the application checklist stating that proof of U.S. citizenship is required, if the consumer applying for Medicaid claims U.S. citizenship. The Rights and Responsibilities page is revised to add information about the requirement to provide proof of U.S. citizenship and cooperating with establishing paternity and third party medical support. JFS 07220 "Healthy Start/Healthy Families Checklist" (Revised 10/2006) The CDJFS sends this notice to the consumer to request information before a determination of Healthy Start/Healthy Families eligibility can be made. JFS 07227 "Healthy Start/Healthy Families Follow-Up Letter" (Revised 10/2006) The CDJFS sends this follow-up notice to the consumer to request necessary information from the consumer before a determination of eligibility can be completed.

JFS 07236 "Your Rights and Responsibilities/Medicaid Health Coverage" (Revised 10/2006) This form is revised so that its content is consistent with the JFS 07161 and JFS 07216 Rights and Responsibilities pages. Information is added to inform individuals of the requirement to provide proof of U.S. citizenship and to cooperate with the establishment of paternity and third party medical support. Desk aids and presentations are available in the eManual Contents section of the Medicaid Eligibility Manual (MEM). MEM Instructions:


Chapter 2 5101:1-38-02 (Effective October 6, 2003)

5101:1-38-02 (Effective September 25, 2006)

This information is also available on the Internet and may be accessed at: ODJFS Electronic Manuals http://emanuals.odjfs.state.oh.us/emanuals InnerWeb Calendar: http://www.odjfs.state.oh.us/lpc/calendar/staff/ Internet Calendar: http://www.odjfs.state.oh.us/lpc/calendar/

MEMTL 31 (Revisions to the "Request for Cash, Food Stamp, and Medical Assistance, "JFS 07200)

Food Stamp Transmittal Letter No. 277 Cash Assistance Manual Transmittal Letter No. 27 Medicaid Eligibility Manual Transmittal Letter No. 31

August 24, 2006

TO: Food Stamp Certification Handbook Holders Cash Assistance Manual Holders Medicaid Eligibility Manual Holders

FROM: Barbara E. Riley, Director SUBJECT: Revisions to the "Request for Cash, Food Stamp, and Medical Assistance, "JFS 07200

Reason for Changes In order to comply with federal requirements outlined in the Deficit Reduction Act of 2005, the following changes are being made to the JFS 07200, "Request for Cash, Food Stamp, and Medical Assistance". The new Medicaid citizenship requirement in rule 5101:1-38-02 of the Administrative Code will be effective September 25, 2006. Utilization of the revised JFS 07200 should be used beginning on or after October 1, 2006. Description of the Revisions to the "Request for Cash, Food Stamp, and Medical Assistance, "JFS 07200 Application Coversheet, Page Two, "What type of verification do I need?" The first bullet immediately underneath the heading has been revised to read "If you are not a U.S. citizen and are only applying for alien emergency medical assistance, you do not have to verify your citizenship status or immigration status, or provide a social security number." Adding "or immigration status" will help to clarify that the individual does not have to provide INS documents for alien emergency medical assistance. The second line item of the verification chart has been revised to read "Permanent Resident Card ("green card") or other INS documentation if not a U.S. citizen" to use terminology commonly understood by applicants. Since proof of citizenship status is required for all individuals applying for any category of Medicaid and Cash Assistance Programs, "Proof of U.S. citizenship if a U.S. citizen" has been added as the third line item of the verification needed for Medical Assistance and Cash Assistance Programs. Annuities have been included on the seventh line item, "Proof of current value of stocks/bonds, certificates of deposit, life insurance, trusts, annuities. " Page Two of the Application, Section Six: "Tell us about the people in your home" The question "Are you married?" has been added under the chart requesting information about household members. Page Three of the Application, Section Seven: "Tell us about your finances" In the second question, annuities have been added as an example of resources that an assistance group may possess. Page Four of the Application, Section Nine: "Signature of person who completed this application" A statement has been added as the second bullet that attests that all annuities and other similar financial devices in which the assistance group has any interest have been reported by the applicant or the authorized representative.

Miscellaneous The Spanish and Somali versions of the JFS 07200 will be issued under separate cover at a later date. INSTRUCTIONS: FOOD STAMPS:

LOCATION REMOVE AND FILE AS OBSOLETE

INSERT/REPLACEMENT

Appendix 101-A JFS 07200, Request for Cash, Food Stamp, and Medical Assistance (Rev. 05/2005)

JFS 07200, Request for Cash, Food Stamp, and Medical Assistance (Rev. 10/2006)

Appendix 35 Record of Changes to Handbook

N/A Update with the number and date of this transmittal

INSTRUCTIONS: CASH ASSISTANCE:


INSERT/REPLACEMENT

CAM APPENDIX JFS FORMS

Outline of Contents (Effective August 1, 2006)

Outline of Contents (Effective October 1, 2006)

JFS 07200 Request for Cash, Food Stamp, and Medical Assistance (Rev. 05/01/05)

JFS 07200 Request for Cash, Food Stamp, and Medical Assistance (Rev. 10/2006)

INSTRUCTIONS: MEDICAL ELIGIBILITY MANUAL:


INSERT/REPLACEMENT

MEM APPENDIX JFS FORMS

JFS 07200 Request for Cash, Food Stamp, and Medical Assistance (Rev. 05/01/05)

JFS 07200 Request for Cash, Medical and Food Stamp Assistance (Rev. 10/2006)

MEMTL 30 (Medicaid: income and patient liability determinations for individuals under the assisted living home and community based waiver) Medicaid Eligibility Manual Transmittal Letter No. 30

July 6, 2006

To: All Medicaid Eligibility Manual Holders From: Barbara E. Riley, Director Subject: Medicaid: income and patient liability determinations for individuals under the assisted

living home and community based waiver.

House Bill 66 of the 126th General Assembly established a new Home and Community Based Services waiver to allow individuals to receive Medicaid services while residing in an assisted living facility. This new rule addresses the income, personal needs allowance and patient liability for those individuals. Effective date: July 1, 2006 Chapter 3 Medicaid: income and patient liability determinations for individuals under the assisted living home and community based waiver. Individuals who enroll in the new Assisted Living Waiver effective July 1, 2006 are required to contribute toward the cost of Medicaid services if their income is above a specific amount. These individuals are evaluated at the Special Income Limit (SIL), similar to the income evaluation of all other individuals who are enrolled in HCBS, PACE, or who are considered institutionalized in a long term care facility. This companion rule (to rules 5101:1-39-23 and 5101:1-39-24) addresses only those differences in calculating income, personal needs allowance and patient liability for those enrolled in the Assisted Living Waiver. This rule references the other two rules and must be read in conjunction with the other rules. Medicaid is prohibited by federal law from paying for room and board; therefore, instead of the special individual maintenance needs allowance or the personal needs allowance for institutionalized individuals, these consumers are allowed a special assisted living waiver maintenance needs allowance (ALMNA) designed to provide for room, board, and personal needs. There are a total of 1800 waiver "slots" available to individuals on this waiver. Eligibility requirements to enroll in the waiver after determination of Medicaid eligibility are addressed in new rules 5101:3-1-06.5 and 5101:3-33-02 to 5101:3-33-07 of the Administrative Code which are effective on July 1, 2006. MEM Instructions:

Location Remove Insert

Chapter 3 5101:1-39-24.1

This information is also available on the Internet and may be accessed at: ODJFS Electronic Manuals http://emanualstest.odjfs.state.oh.us/emanuals InnerWeb Calendar: http://www.odjfs.state.oh.us/lpc/calendar/staff/ Internet Calendar: http://www.odjfs.state.oh.us/lpc/calendar/

MEMTL 29 (Medicaid: Social Security Number Requirement) Medicaid Eligibility Manual Transmittal Letter No. 29

May 19, 2006

To: All Medicaid Eligibility Manual Holders From: Barbara E. Riley, Director Subject: Medicaid: Social Security Number Requirement.

This MEMTL contains rule 5101:1-38-02.1 of the Administrative Code, "Medicaid: Social Security number requirement". This new rule replaces rule 5101:1-38-021 of the Administrative Code. The rule was reviewed in accordance with section 119.032 of the Revised Code. Effective date: July 1, 2006 Chapter 2 Medicaid: Social Security Number Requirement - 5101:1-38-02.1 Rule 5101:1-38-02.1 of the Administrative Code is a new rule that more closely reflects the language as outlined in the Code of Federal Regulations (CFR) regarding the requirement for individuals applying for medical assistance to provide a Social Security number. The policy regarding the Social Security number requirement has not changed. Medicaid policy requires individuals applying for medical assistance to provide a Social Security number. Therefore, an individual applying on behalf of another individual, or other household members who are listed on the medical assistance application do not have to provide a Social Security number unless they are applying for medical assistance for themselves. New federal language is added to paragraph (C)(3) requiring the administrative agency to assist an individual in completing an application for a Social Security number in certain situations. To assist administrative agencies in implementing this requirement, the internet link for the Social Security card application is listed at: http://www.ssa.gov/online/ss-5.pdf. MEM Instructions:



5101:1-38-02.1 (Effective July 1, 2006)

This information is also available on the Internet and may be accessed at: Medicaid Eligibility Manual (MEM) http://emanuals.odjfs.state.oh.us/emanuals ODJFS Electronic Manuals http://emanuals.odjfs.state.oh.us/emanuals InnerWeb Calendar: http://www.odjfs.state.oh.us/lpc/calendar/staff/ Internet Calendar: http://www.odjfs.state.oh.us/lpc/calendar/

MEMTL 28 (Medicaid: Healthy families eligibility change from 100% federal poverty level (FPL) to 90% FPL


To: All Medicaid Eligibility Manual Holders From: Barbara E. Riley, Director Subject: Medicaid: Healthy families eligibility change from 100% federal poverty level (FPL) to

90% FPL

This MEMTL contains five rules from Chapter 5101:1-40 of the Administrative Code that were amended to implement the 2006-2007 budget initiative that reduced the Healthy Families parental eligibility from one-hundred percent to ninety percent of the federal poverty level. These changes were initiated by Am. Sub. HB 66 of the 126th General Assembly. These rules were also reviewed in accordance with Section 119.032 of the Revised Code. The effective date of this MEMTL is: January 1, 2006. Chapter 4 5101:1-40-02.1 "Covered families and children medicaid: low-income families (LIF) and OWF" This rule was amended to reflect the ninety percent eligibility FPL standard for parents and to correct OAC references. 5101:1-40-20.4 "ADC-related medicaid: earned income" This rule was amended to change CDHS references to CDJFS and JTPA references to WIA and to reflect the ninety percent eligibility FPL standard for parents. 5101:1-40-22 "Covered families and children (CFC) medicaid: allocating income to members of an assistance group" This rule was amended to reflect the ninety percent eligibility FPL standard for parents. 5101:1-40-25 "Covered families and children medicaid: low income families medicaid (LIF) budgeting methodologies" This rule was amended to change CDHS references to CDJFS, remove an inaccurate OAC reference, and to reflect the ninety percent eligibility FPL standard for parents. 5101:1-40-26 "Medicaid: standards of need and pregnancy allowance" This rule was amended to reflect the ninety percent eligibility FPL standard for parents and to correct a misspelled word. Effective January 1, 2006, income eligibility for healthy families Medicaid cannot exceed 90% of the FPL. The 90% FPL standard shall be used on all applications received and eligibility redeterminations completed on or after January 1, 2006. For all applications received and for eligibility redeterminations completed prior to January 1, 2006, the 100% FPL standard must be applied. Two new reason codes must be used when denying or terminating any healthy families Medicaid application due to income exceeding 90% of the FPL. These codes will become effective on January 1, 2006, when the new poverty standard can be applied to new applications and redeterminations. The new reason codes and the 90% federal poverty level dollar figures are located in Medicaid Eligibility Procedure Letter No. 6, issued on November 28, 2005. MEM Instructions:


Chapter 4 5101:1-40-02.1 (Effective July 1, 2000) 5101:1-40-02.1 (Effective January 1, 2006)

Chapter 4 5101:1-40-20.4 (Effective January 26, 1998)

5101:1-40-20.4 (Effective January 1, 2006)

Chapter 4 5101:1-40-22 (Effective August 30, 2002) 5101:1-40-22 (Effective January 1, 2006)

Chapter 4 5101:1-40-25 (Effective July 1, 2000) 5101:1-40-25 (Effective January 1, 2006)

Chapter4 5101:1-40-26 (Effective June 1, 2003) 5101:1-40-26 (Effective January 1, 2006)

This information is also available on the Internet and may be accessed at: Medicaid Eligibility Manual (MEM) http://emanuals.odjfs.state.oh.us/emanuals/ohpeligibility/MEM ODJFS Electronic Manuals http://emanuals.odjfs.state.oh.us/emanuals InnerWeb Calendar: http://www.odjfs.state.oh.us/lpc/calendar/staff/ Internet Calendar: http://www.odjfs.state.oh.us/lpc/calendar/

MEMTL 27 (Medicaid: outstationing workers at disproportionate share hospitals and federally qualified health centers)


To: All Medicaid Eligibility Manual Holders From: Barbara E. Riley, Director Subject: Medicaid: outstationing workers at disproportionate share hospitals and federally

qualified health centers.

The Ohio Department of Job and Family Services (ODJFS) reviewed this rule in accordance with section 119.032 of the Revised Code. This MEMTL contains one rule of the Administrative Code: 5101:1-38-04 "Medicaid: outstationing workers at disproportionate share hospitals and federally qualified health centers." This new rule clarifies the administrative agency's role in facilitating outreach services for pregnant women and children through the process of outstationing at disproportionate share hospitals and federally qualified health centers. The effective date of this MEMTL is: January 1, 2006. Chapter 2 5101:1-38-04 Medicaid: outstationing at disproportionate share hospitals and federally qualified health centers. Rule 5101:1-38-04 of the Administrative Code is a new rule that replaces rule 5101:1-38-04 of the Administrative Code. Rule 5101:1-38-04, with an effective date of 07/01/2000, will be rescinded effective with this MEMTL. The new rule has format changes to make it consistent with other new rules in the Medicaid Eligibility Manual and clarifies the administrative agency's role in facilitating outreach services for pregnant women and children through the process of outstationing at disproportionate share hospitals and federally qualified health centers. MEM Instructions:





MEMTL 26 (Budgeting Methodology For Individuals Under Age Twenty-One Not Living With A Parent Or Spouse)


To: All Medicaid Eligibility Manual Holders From: Barbara E. Riley, Director Subject: Medicaid: budgeting methodology for individuals under age twenty-one not living with a

parent or spouse.

The Ohio Department of Job and Family Services (ODJFS) reviewed this rule in accordance with section 119.032 of the Revised Code. This MEMTL contains one rule of the Administrative Code: 5101:1-40-25.1 "Medicaid: budgeting methodology for individuals under age twenty-one not living with a parent or spouse." This new rule clarifies the budgeting methodology for individuals under the age of twenty-one not living with a parent or spouse. Individuals requesting Medicaid under this category must meet all eligibility criteria applicable to such individuals in chapters 5101:1-37 through 5101:1-42 of the Administrative Code. The effective date of this MEMTL is: January 1, 2006. Chapter 4 5101:1-40-25.1 Medicaid: budgeting methodology for individuals under age twenty-one not living with a parent or spouse. Rule 5101:1-40-25.1 of the Administrative Code is a new rule that replaces rule 5101:1-40-251 of the Administrative Code. Rule 5101:1-40-251 will be rescinded effective with this MEMTL. The new rule has format changes to make it consistent with other new rules in the Medicaid Eligibility Manual and clarifies the category of "individuals under the age of twenty-one not living with a parent or spouse." MEM Instructions:



5101:1-40-25.1 (Effective January 1, 2006)


MEMTL 25 (Disability Medical Assistance (DMA) Program


To: All Medicaid Eligibility Manual Holders From: Barbara E. Riley, Director Subject: Disability Medical Assistance (DMA) program

Rule 5101:1-42-01 of the Administrative Code is a new rule that will replace the existing Disability Medical Assistance (DMA) rule. In addition to the revised DMA rule, the Medicaid eligibility section revised the JFS form that a physician is required to sign to certify that an individual meets the definition of "medication dependency", the JFS 03606. The effective date of this MEMTL is January 1, 2006. Background: In accordance with Medicaid Information Letter (MIL) 04-015, the Disability Medical Assistance (DMA) program is under an Administrative Order to suspend the approval of all applications for DMA. Under this administrative order, all county departments of job and family services (CDJFS) shall deny all new applications for the DMA program until the order is revised or rescinded. The DMA program is a state administered program with no federal funding. Because DMA is funded with 100% state resources, ODJFS has taken aggressive steps to contain costs within the program. In July 2005, Amended Substitute House Bill (HB 66), Ohio's Biennial Budget Bill, authorized the continuance of the DMA program and the creation of the Disability Medical Assistance Council. The charge of the DMA Council was to analyze the existing DMA program and make recommendations for policy changes for a replacement program to be implemented in 2006. The Council was comprised of representatives from ODJFS, County agencies, the Ohio Hospital Association, Ohio United Way, Ohio Department of Mental Health, Ohio State Legal Services, other advocacy organizations and State agencies. The DMA Council prepared a report with recommendations for the DMA replacement program and provided it to the Ohio General Assembly on September 1, 2005. Rule 5101:1-42-01 of the Administrative Code and the form to certify "medication dependency" have been revised accordingly. Chapter 5 5101:1-42-01 Disability Medical Assistance (DMA) Program Significant changes to this rule are: 1. A revised definition of "medication dependency", in paragraph (B); 2. A requirement for the CDJFS to explore medicaid eligibility at the time of application or

redetermination for DMA eligibility, in paragraph (F); 3. A requirement for individuals to apply for any disability benefits to which they may be entitled

as a condition of DMA eligibility, in paragraph (F); and 4. Removal of the pre-termination review (PTR) requirement for Medicaid or medical assistance

prior to terminating a DMA case. NOTE: There is a significant policy change with regard to conducting a pre-termination review (PTR) prior to terminating DMA eligibility. The previous rule (effective September 5, 2003) did not permit the county agency to terminate DMA until a pre-termination review of continuing eligibility for Medicaid was completed. This requirement to conduct a pre-termination review prior to terminating DMA eligibility is eliminated effective January 1, 2006. At DMA redeterminations on or after January 1, 2006, if the individual no longer meets the DMA eligibility criteria, the county agency must propose termination of DMA. This means that the county agency must propose DMA termination even if there is a Medicaid eligibility determination pending.

Appendix JFS Forms The JFS 03606, "Disability Medical Assistance (DMA) Physician Certification of Medication Dependency" is revised to reflect the revised definition of "medication dependency". MEM Instructions:


Chapter 5 5101:1-42-01 (Effective September 5, 2003)


Appendix / JFS Forms

JFS 03606 (Rev. 4/2001) JFS 03606 (Rev. 9/2005)


MEMTL 24 (Coverage for an Individual Added to an Ongoing Case)


To: All Medicaid Eligibility Manual Holders From: Barbara E. Riley, Director Subject: Medicaid: Coverage for an individual added to an ongoing case

This MEMTL rescinds one rule of the Administrative Code: 5101:1-40-093 "Covered families and children medicaid: coverage for an individual added to an ongoing case." The effective date of this MEMTL is: December 1, 2005 This rule has been reviewed in accordance with Section 119.032 of the Revised Code and is proposed for rescission. The content of this rule is duplicated within other existing Medicaid eligibility rules. The rescission of this rule does not impact an individual's eligibility for Medicaid. Chapter 4 5101:1-40-093 Covered families and children Medicaid: coverage for an individual added to an ongoing case. The content of this rule is duplicated within the following Medicaid eligibility rules:

• Determination of eligibility for Medicaid is addressed in rule 5101:1-38-01

• The beginning date of eligibility for an individual added to an existing assistance group is defined in rule 5101:1-38-01.4

• Assistance groups are defined in rule 5101:1-40-01

• Covered groups are defined in rule 5101:1-40-01.1

• Retroactive coverage is defined in rule 5101:1-38-01.3

• Reporting changes is addressed in rule 5101:1-38-02

• Pre-termination review of continuing Medicaid eligibility and prior notice requirements are defined in rule 5101:1-38-01.1 and division-level designation 5101:6 of the OAC

• Coverage for newborns is addressed in 5101:1-40-02.2. Fiscal Impact The rescission of this rule does not impose any new requirements on county agencies and therefore, the implementation of the rule change should result in no fiscal impact on the county agencies. Training Statement The rescission of this rule will not require training or technical assistance to be provided to county staff by ODJFS. Clarification regarding the rescinded rule will be available to county staff through the CFC Technical Assistance staff and the ABD Technical Assistance staff. MEM Instructions:


Chapter 4 5101:1-40-093 (Effective July 1, 2005) Not Applicable

This information is also available on the Internet and may be accessed at: Medicaid Eligibility Manual (MEM) http://emanuals.odjfs.state.oh.us/emanuals/ohpeligibility/MEM ODJFS Electronic Manuals

http://emanuals.odjfs.state.oh.us/emanuals InnerWeb Calendar: http://www.odjfs.state.oh.us/lpc/calendar/staff/ Internet Calendar: http://www.odjfs.state.oh.us/lpc/calendar/

MEMTL 23 (Healthchek and Pregnancy Related Services)

Medicaid Eligibility Manual Transmittal Letter No. 23 August 4, 2005

To: All Medicaid Eligibility Manual Holders From: Barbara E. Riley, Director Subject: Medicaid: early and periodic screening, diagnosis and treatment (EPSDT) -

"Healthchek"

Medicaid: pregnancy related services (PRS)

• This MEMTL contains two rules from Chapter 5101:1-38 of the Administrative Code. • These amended rules clarify documentation requirements for the administrative agency

concerning the management of the Healthchek and Pregnancy Related Services programs. The documentation that the state currently has on file (Program Implementation Plans or Letters) is obsolete and must be updated. This rule is necessary to meet compliance measures established by the federal Centers for Medicare and Medicaid Services (CMS) for monitoring and evaluation of these Medicaid programs.

Effective date: October 15, 2005 Chapter 5 Medicaid: early and periodic screening, diagnosis and treatment (EPSDT) - "Healthchek." OAC rule 5101:1-38-05 This rule is amended to include language that requires CDJFS agencies to submit in writing, under signature of the CDJFS director, a description of the process and structure of the management of the local Healthchek program including the name of the contact person and/or coordinator for the program. Medicaid: pregnancy related services (PRS). OAC 5101:1-38-06 This rule is amended to include language that requires CDJFS agencies to submit in writing, under signature of the CDJFS director, a description of the process and structure of the management of the local pregnancy related services (PRS) program including the name of the contact person and/or coordinator for the program. Submission of a Local Program Management Description (LPMD) for the HEALTHCHEK and Pregnancy Related Services (PRS) Programs The Centers for Medicare and Medicaid Services (CMS) has recommended that the State of Ohio provide technical assistance as needed to all 88 counties to enhance the understanding of the Healthchek and PRS programs. In an effort to respond to this recommendation and effectively monitor these programs at the local level, ODJFS is requiring each county department of job and family services (CDJFS) to submit an updated LPMD for the Healthchek and PRS programs within their agencies. Requirements such as provision of beneficiary information and case management of support services will be reviewed. Rules 5101:1-38-05 and 5101:1-38-06 pertaining to 'Documentation Requirements' for both programs are updated to reflect the need for each CDJFS to submit a LPMD for these programs. This will allow ODJFS to monitor each county based on the structure outlined within their LPMD. The attached instructions for creating the LPMD and suggested templates are included as an attachment in this MEMTL to assist you in preparing the information that will be needed for the document. If you have any questions, please contact the OHP County Compliance Section at (614) 728-8476 or submit inquiries through the Healthchek_PRS GroupWise mailbox. Please reference 'LPMD' in the subject line of the e-mail.

MEM Instructions:


Chapter 5 5101:1-38-05 (Effective October 6, 2003)


Chapter 5 5101:1-38-06 (Effective October 6, 2003 )



MEMTL 22 (Eligibility Determinations and Patient Liability)

Medicaid Eligibility Manual Transmittal Letter No. 22 June 20, 2005

To: All Medicaid Eligibility Manual Holders From: Barbara E. Riley, Director Subject: Medicaid eligibility determinations and patient liability determinations for

• Individuals in institutions,

• Individuals receiving home and community-based services, and

• Individuals receiving services under the Program of All Inclusive Care for the Elderly (PACE)

This MEMTL contains fifteen rules from Chapter 5101:1-39 of the Administrative Code. These new and amended rules clarify the process of determining eligibility using the special income level and determining patient liability for certain institutionalized individuals, individuals receiving services under the HCBS waiver program or PACE. The new rules are formatted consistent with other new rules in the Medicaid Eligibility Manual (MEM). The most significant change occurs in new rule 5101:1-39-24, which adjusts the application of patient liability in partial months of institutionalization. Previously individuals were not held responsible for providing these payments in partial months of admission, discharge, or death. Due to federal clarification, we must now prorate the patient liability amount in these partial months. The rule explains the simple formula and requires that the administrative agency hold the individual responsible for this share of costs. The effective date for all rules is July 1, 2005. Chapter 3 The following rules are new: 5101:1-39-23 Medicaid: income computations for determining eligibility under covered groups using the special income level. This rule is based on paragraph (A) of rescinded rule 5101:1-39-22.2 and paragraphs (A) through (F) of rescinded rule 5101:1-39-95. Portions of these two rescinded rules that address patient liability are also included in new rule 5101:1-39-24. This new rule includes references to individuals receiving services under the HCBS waiver program or PACE. 5101:1-39-24 Medicaid: income computations for determining patient liability. This new rule is based on portions of rescinded rules 5101:1-39-12, 5101:1-39-22.1, 5101:1-39-22.2, 5101:1-39-22.3, 5101:1-39-22.4, 5101:1-39-22.6, 5101:1-39-85, and 5101:1-39-95 that address determination of patient liability. This rule explains that when an individual is institutionalized for less than a full month, the administrative agency must prorate the amount of patient liability. This is explained in paragraph (C) (2) (i). This new rule also includes references to individuals receiving services under the HCBS waiver program or PACE. The following rules are amended: 5101:1-39-01.1 Medicaid: low-income medicare assistance programs. This rule is amended to include language regarding the determination of QMB and SLMB eligibility, previously addressed in rescinded rule 5101:1-39-22.2. It also includes language regarding

individuals receiving services under HCBS waiver program or PACE, removes references to the Qualified-Individual-2 (QI-2) group, and makes minor clarifications and grammatical corrections. 5101:1-39-35 Medicaid: resource assessment. This rule is amended to include language regarding the treatment of resources in HCBS waiver cases, previously addressed in rescinded rule 5101:1-39-95 and to make minor clarifications and grammatical corrections. This rule includes references to individuals receiving services under the HCBS waiver program or PACE. 5101:1-39-05 Medicaid: resource requirement. This rule is amended to remove references to rescinded rule 5101:1-39-95, include a reference to amended rule 5101:1-39-35, and to make minor clarifications and grammatical corrections. This rule includes references to individuals receiving services under the HCBS waiver program or PACE. 5101:1-39-08 Medicaid: income. This rule is amended to remove references to rescinded rules 5101:1-39-22.2, 5101:1-39-22.4, and 5101:1-39-22.1 and replace with references to new rule 5101:1-39-24, and to make minor clarifications and grammatical correct

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