Rule 173-51-02 | Assisted living program (state-funded component): eligibility requirements.
(A) Only an individual meeting all of the following qualifications is eligible for the state-funded component of the assisted living program:
(1) Consultation: The individual participated in a long-term care consultation under section 173.42 of the Revised Code and Chapter 173-43 of the Administrative Code.
(2) Financial requirements:
(a) The individual contacted either ODA's designee or ODM's administrative agency to apply for the medicaid-funded component of the assisted living program, but the application is still pending because ODM's administrative agency has not yet made a final determination on the individual's financial eligibility. If ODM's administrative agency already determined the individual was eligible to participate in the medicaid-funded component of the assisted living program, the individual would enroll into the medicaid-funded component of the assisted living program. If ODM's administrative agency already determined the individual was not financially eligible to participate in the medicaid-funded component of the assisted living program, the individual would also not be eligible to participate in the state-funded component of the assisted living program.
(b) The individual agreed that, if the individual enrolls into the state-funded component of the assisted living program, and ODM's administrative agency determines the individual is financially eligible for the medicaid-funded component of the assisted-living program, then the individual would transfer immediately to the medicaid-funded component of the assisted living program.
(c) The individual is cooperative and actively assisting ODM's administrative agency in determining if the individual is financially eligible to participate in the medicaid-funded component of the assisted living program by timely providing ODM's administrative agency with information and copies of any records ODM's administrative agency needs to make its financial eligibility determination.
(d) ODA or its designee determined that ODM's administrative agency would most likely determine that the individual meets all financial eligibility requirements for the medicaid-funded component of the assisted living program listed in rules 5160:1-2-03 and 5160:1-2-10 of the Administrative Code.
(3) Non-financial requirements:
(a) ODA or its designee and the individual entered into an enrollment agreement, and the form indicated the individual chose to enroll in the state-funded component of the assisted living program, named the individual's representative (if any), and authorized ODA or its designee to release information.
(b) ODA or its designee determined the individual meets all non-financial eligibility requirements for the medicaid-funded component of the assisted living program in rule 5160-33-03 of the Administrative Code.
(c) The individual agreed to reside in a resident unit of a certified RCF while receiving assisted living services under the state-funded component of the assisted living program that meets the requirements for resident units in rule 173-39-02.16 of the Administrative Code.
(4) Post-eligibility treatment of income (PETI) (i.e., patient liability or share of cost): After ODA or its designee assessed the individual's income and resources using the methodology described in rule 5160:1-6-07.1 of the Administrative Code to determine if the individual should pay any share of cost and the individual agreed to pay, and does pay, any share of cost as it becomes due.
(B) If, at any time, an individual enrolled in the state-funded component of the assisted living program no longer meets all the requirements under paragraph (A) of this rule, unless the only requirement the individual no longer meets is the PETI requirement in paragraph (A)(5) of this rule, the individual is no longer eligible for the state-funded component of the assisted living program.
(C) An individual who is eligible for the state-funded component of the assisted living program is not eligible to participate in the state-funded component of the assisted living program for more than ninety days, unless ODA's director approved an extended number of days.
(D) ODA's designee may allow an individual to provide verbal agreement for intent to enroll in the state-funded component of the assisted living program at the time of assessment if unable to provide a unique identifier of the individual. ODA's designee may collect the unique identifier of the individual for the agreements required in paragraphs (A)(2)(b), (A)(3)(a), (A)(3)(c), and (A)(4) of this rule no later than thirty days after the individual's original enrollment date.
Last updated February 1, 2023 at 1:27 PM
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