SI CHI01730.011 (OH) Ohio Medicaid (RTN 404 -- 03/2007)
The Department of Job and Family Services in Ohio is the agency with the authority to establish and supervise the state's medical assistance program. The program is in operation statewide through the County Departments of Job and Family Services (CDJFS). Applications for Medicaid are taken at, and processed by, the county departments. Applications for the Breast and Cervical Cancer Project (BCCP) Medicaid program are taken and processed by the Ohio Department of Job and Family Services (ODJFS).
Since the Social Security Administration does not determine Medicaid eligibility in the State of Ohio, the following material is for informational purposes only. It provides a general background on Medicaid eligibility in Ohio. Claimants requesting more specific information or wishing to apply for Medicaid should be referred to the Ohio Medicaid Consumer Hotline (1-800-324-8680) or the CDJFS or, for BCCP Medicaid, to ODJFS.
B. Eligibility and the January 1, 1980 Changes
In determining Medicaid eligibility, the state has elected to use eligibility criteria that are more restrictive than those for SSI entitlement, though not more restrictive than the Ohio requirements in 1972.
Medicaid eligibility is determined on an individual basis. To be eligible for Medicaid, an applicant must be an Ohio resident; a U.S. Citizen, or a qualified alien; a member of a covered group; and meet all other eligibility criteria including income and resource requirements. Eligibility may be retroactive up to three months prior to the month of application.
C. Covered Groups for Medicaid
1. Covered Families and Children (CFC) Group
2. Aged, Blind and Disabled Groups
The standard (or regular) groups are those aged, blind, or disabled persons who meet all Medicaid eligibility requirements and have income less than or equal to the financial need standard. The other groups listed below must meet all the same requirements, plus the variations noted for each group.
The “spend down” group has countable income (as determined under the Medicaid program) in excess of the financial need standard (see E below). This group becomes eligible for Medicaid when the financial need standard is met after deducting the cost of allowable medical expenses from their excess income.
The nursing home group includes those individuals who require nursing home care.
The philanthropic long term care facility group includes individuals who have life-care contracts with such homes that have proven they are financially unable to continue operating.
D. Resource Requirements for Aged, Blind and Disabled Groups
One automobile that is specifically equipped for a disabled person, necessary for employment, necessary for treatment of specific or regular medical problems, or necessary because of climate, terrain, distance or similar factors, for the performance of essential daily activities may be excluded. If not excluded for one of these reasons, the first $4,500 is exempt with the remaining value counted as a resource, without regard to liens or encumbrances.
One burial plot per immediate family member is exempt.
Irrevocable pre-need burial contracts are exempt.
The home that is owned and is being lived in by the individual is considered the principal place of residence and is exempt.
Where an eligible individual resides with an ineligible spouse, resources are determined as they would be for an eligible couple. Where a child under age 18 resides with his parents, the above exclusions apply to the ineligible parents, and then again to the eligible child except that only one home and one automobile are exempt.
E. Income Requirements for Aged, Blind and Disabled Groups
For Ohio Medicaid, income exclusions are similar to those used when determining SSI eligibility, including a $20/month general income disregard and a disregard of $65/month plus one half the remainder of earned income. SSI payments are not considered countable income for Medicaid purposes. Effective January 1, 1980, Ohio Medicaid calls for deeming income from an ineligible spouse or for a child under age 18, deeming income from his/her parents. To be eligible for Medicaid, the total monthly countable (including deemed) income must not exceed the following limits:
Own Household $543
Own Household $934
F. Identification of Medicaid Eligible Individuals
Since Ohio makes its own eligibility determinations for Medicaid, field offices will not answer Medicaid questions (refer to MSSICS screens instead). For Medicaid information, SSI applicants should be referred to a specific CDJFS based upon the county of residence.