Rule 5160:1-2-14. Medicaid: continuous eligibility for children younger than age nineteen

111.15 (A) This rule describes the twelve-month period of continuous eligibility for a child younger than age nineteen, and the conditions under which the child's coverage ends during the twelve-month period, as described in section 1902(e)(12) of the Social Security Act (as in effect October 1, 2023). (B) Eligibility criteria. A child remains eligible for coverage despite changes in the child's circumstances for a period of twelve months when the child was found to be eligible for a category of medical assistance other than: (1) Presumptive eligibility as described in rule 5160:1-2-13 of the Administrative Code; (2) Non-citizen emergency medical assistance as described in rule 5160:1-5-06 of the Administrative Code; or (3) Refugee medical assistance as described in rule 5160:1-5-05 of the Administrative Code. (C) Duration. (1) A child's twelve-month period of continuous eligibility begins: (a) On the date that medical assistance began as a result of an initial determination or annual renewal in accordance with rule 5160:1-2-01 of the Administrative Code. (b) Any months of retroactive eligibility received by the child are not included in the twelve-month period of continuous eligibility. (2) The child's coverage shall be terminated during the continuous eligibility period only: (a) Upon oral or written request of the child (when the child is at least eighteen years old) or the child's representative; or (b) When the child: (i) No longer resides in the state of Ohio; or (ii) Dies; or (iii) Has not paid the premium amounts required for coverage, when the child is covered under the medicaid buy-in for workers with disabilities category described in rule 5160:1-5-03 of the Administrative Code; or (iv) Reaches the age of nineteen. (D) Patient liability, or premium. A patient liability or premium calculated for a child in accordance with Chapters 5160:1-3 to 5160:1-6 of the Administrative Code shall not increase during the child's continuous coverage period. Any decrease in a child's patient liability or premium results in a new maximum amount, which will not increase for the remainder of the child's continuous coverage period. (E) Regardless of a child's status under this rule, payment for services shall not be made when payment is prohibited under rule 5160:1-1-03 of the Administrative Code. Last updated May 5, 2025 at 11:24 AM Supplemental Information Authorized By: 5162.031 , 5163.02 Amplifies: 5163.02 , 5163.03 11/1/2028 1/1/2014