Rule 5160:1-3-02.4 | Medicaid: coverage for the categorically needy.

(A) This rule describes eligibility for aged, blind, or disabled individuals who meet the income and resource requirements of the supplemental security income (SSI) program authorized by the social security administration (SSA) under Title XVI of the Social Security Act (as in effect October 1, 2022) but who do not receive cash benefits under the program. Eligibility for this program shall be determined for applications for medical assistance filed on or after the August 1, 2016 effective date of this rule.

(B) Eligibility criteria. To be eligible under this group, an individual must meet all of the following critiera:

(1) Be aged, blind, or disabled; and

(2) Determinations of blindness and disability must be in accordance with SSA policy; and

(3) Have countable income, as determined under Chapter 5160:1-3 of the Administrative Code, which does not exceed the income standard described in rule 5160:1-3-03.5 of the Administrative Code; and

(4) Have countable resources, as determined under Chapter 5160:1-3 of the Administrative Code, which do not exceed the resource limit described in rule 5160:1-3-05.1 of the Administrative Code; and

(5) Not be receiving cash benefits from the SSI program; and

(6) Meet the conditions of eligibility outlined in rule 5160:1-2-10 of the Administrative Code.

(C) Retroactive coverage is available for this program in accordance with rule 5160:1-2-01 of the Administrative Code, but coverage shall not begin prior to the August 1, 2016 effective date of this rule and shall not provide reimbursement of services rendered prior to the August 1, 2016 effective date of this rule.

Last updated June 26, 2025 at 12:43 AM