5101:2-47-05 Title XIX medicaid coverage for Title IV-E foster care maintenance (FCM) recipients in accordance with the Consolidated Omnibus Budget Reconciliation Act (COBRA).
NOTE: This rule is being reviewed for 14 days for pre-clearance due to 5 year rule review.
(A) Children placed outside Ohio
(1) Within twenty business days after a Title IV-E foster care maintenance (FCM) eligible child's placement out of state, the Ohio Title IV-E agency must take the following actions to transfer Title XIX medicaid coverage to the Title XIX medicaid authority in the state where the child has been placed:
(a) Provide written notifications to the responsible Title XIX medicaid authority in the state in which the child is placed, of Ohio's intent to terminate the medicaid coverage. Notification shall, at a minimum, include the following:
(i) The proposed effective termination date of Ohio's Title XIX medicaid coverage.
(ii) A statement that the out of state agency will continue to receive Title IV-E FCM payments on the child's behalf and the Title XIX medicaid coverage will be provided by the state where the child is placed.
(b) Request written notification of the effective date of Title XIX medicaid coverage from the Title IV-E agency where the child is placed.
(c) Inform the out of state custodial agency of its right to a state hearing in accordance with Chapters 5101:6-1 to 5101:6-9 and rule 5101:6-3-01 of the Administrative Code.
(d) Terminate the Title XIX medicaid coverage in the statewide automated child welfare information system (SACWIS) using the date the out of state Title XIX medicaid coverage begins.
(2) Once every twelve months, provide the responsible Title XIX medicaid authority in the state where the child is placed, with verification of the child continuing to be eligible and reimbursable for Title IV-E FCM.
(3) When the child is not Title IV-E program eligible and reimbursable, provide written notification, within twenty business days of the determination, to the Title XIX medicaid authority in the state where the child is placed.
(B) Children placed in Ohio from another state
(1) Within twenty business days after being notified by a custodial agency from the other state that a Title IV-E FCM eligible child has been placed in Ohio, the following actions must be taken in order to authorize Title XIX medicaid coverage:
(a) The Ohio Title IV-E agency must obtain the following information, in writing, from the custodial agency in another state:
(i) The child's name, social security number and date of birth.
(ii) The substitute care provider's name and address.
(iii) The address where the medicaid card should be sent.
(iv) Verification of eligibility for Title IV-E FCM, which may include an approved Title IV-E FCM application.
(v) The name, address and phone number of a contact person at the custodial agency in another state with Title IV-E case management responsibility.
(vi) The date Title XIX medicaid coverage in the state where the child is placed from will be terminated.
(vii) Any additional information regarding other health insurance coverage the child may have, including third-party liability.
(b) The Ohio Title IV-E agency must enter the appropriate COBRA Title IV-E FCM information in SACWIS which will authorize medicaid coverage.
(c) The Ohio Title IV-E agency must provide written notification of the effective date of Title XIX medicaid coverage to the custodial agency.
(d) The Ohio Title IV-E agency must complete the JFS 06612 "Health Insurance Information Sheet" (rev. 5/2001), if there is information that the child is covered under a health insurance plan.
(2) Once every twelve months, the Ohio Title IV-E agency shall request verification of continuing Title IV-E FCM eligibility and reimbursability from the custodial agency in the state making Title IV-E FCM payments on behalf of a child placed in Ohio. Upon notification from the custodial agency that the child does not meet Title IV-E program eligibility and reimbursability criteria, the Ohio Title IV-E agency shall take steps to:
(a) Terminate Title XIX medicaid coverage in SACWIS and follow the procedures outlined in Chapters 5101:6-1 to 5101:6-9 of the Administrative Code, in particular, rule 5101:6-3-01 of the Administrative Code.
(b) Advise the custodial agency that Ohio Title XIX medicaid coverage on behalf of the child may be explored.
(C) The Title IV-E agency shall maintain a separate case record for each Title IV-E FCM recipient who is placed in Ohio by an out of state custodial agency. At a minimum, the case record shall contain all of the information required in paragraph (D) of this rule.
(D) A child who is eligible for Title IV-E FCM in Ohio shall not be denied Title XIX medicaid coverage if the other state does not make Title XIX medicaid coverage available.
Cite as Ohio Admin. Code 5101:2-47-05
R.C. 119.032 review dates: 06/01/2018
Promulgated Under: 119.03
Statutory Authority: 5153.16, 5101.141, 5103.03
Rule Amplifies: 5103.03 , 5153.16, 5101.141
Prior Effective Dates: 9/30/87 (Emer.), 12/27/87, 5/1/98, 9/1/03, 10/8/07