Rule 5160:1-4-06 | Medicaid: coverage for individuals in receipt of adoption or foster care assistance.

(a) Meet the age requirements identified in Chapter 5101:2-47 of the Administrative Code and be in the custody of a public children services agency (PCSA), private child placing agency (PCPA), or Title IV-E agency and in receipt of Title IV-E foster care maintenance payments; or

(b) Meet the age requirements identified in Chapter 5101:2-49 of the Administrative Code and have a Title IV-E adoption agreement in effect, whether or not an adoption assistance payment is being made or a judicial decree of adoption has been issued.

(2) When the individual receives adoption or foster care assistance under Title IV-E of the Social Security Act and meets the eligibility criteria under this paragraph, there is no income or resource test required to be eligible for medical assistance.

(D) Eligibility criteria for an individual in receipt of kinship guardianship assistance program (KGAP) payments under Title IV-E of the Social Security Act (as in effect October 1, 2023).

(1) The individual must:

(a) Meet the eligiblity requirements identified in rule 5101:2-46-02 or rule 5101:2-55-02 of the Administrative Code; and

(b) Have a current IV-E KGAP or IV-E kinship guardianship assistance program connections to twenty-one (KGAP C21) agreement in effect.

(2) When the individual receives KGAP payments under Title IV-E of the Social Security Act and meets the eligiblity criteria under this paragraph, there is no income or resource test required to be eligible for medical assistance.

(E) Eligibility criteria for an individual in receipt of state foster care assistance.

(1) The individual must:

(a) Be in the custody of a PCSA, PCPA, or Title IV-E agency; and

(b) Be in receipt of state foster care assistance.

(2) When the individual receives state foster care assistance and meets the eligibility criteria under this paragraph, there is no income or resource test required to be eligible for medical assistance.

(3) Eligibility is coterminous with receipt of foster care assistance and ends on the date the child's foster care placement ends, subject to a pre-termination review as defined in rule 5160:1-1-01 of the Administrative Code.

(F) Eligibility criteria for an individual in receipt of a state adoption maintenance subsidy.

(1) The individual must:

(a) Meet the age requirements identified in rule 5101:2-44-06 of the Administrative Code; and

(b) Have a state adoption agreement in effect, whether or not a judicial decree of adoption has been issued.

(2) When the individual receives a state adoption maintenance subsidy and meets the eligibility criteria under this paragraph, there is no income or resource test required to be eligible for medical assistance.

(G) Eligibility criteria for an individual in receipt of state adoption assistance in accordance with 42 C.F.R. 435.227 (as in effect October 1, 2023).

(1) The individual must:

(a) Be under the age of twenty-one; and

(b) Have been determined by the PCSA responsible for determining state adoption maintenance subsidy program eligibility to have special needs for medical or rehabilitative care that may be a barrier to the adoptive placement, as described in rule 5101:2-44-05.1 of the Administrative Code, or have a state adoption subsidy agreement in effect with another state, as described in rule 5101:2-44-05.2 of the Administrative Code; and

(c) Have been receiving or eligible to receive medicaid prior to the execution of the adoption agreement, under any category of medical assistance.

(2) When the individual receives state adoption assistance, has special needs for medical or rehabilitative care, and meets the eligibility criteria under this paragraph, there is no income or resource test required to be eligible for medical assistance.

(H) An individual who meets eligibility requirements identified in rule 5101:2-56-02 of the Administrative Code and is in receipt of state KGAP payments is not eligible for medical assistance under this rule on the basis of receiving KGAP payments.

Last updated June 25, 2025 at 6:40 PM