(A)Children placed outside Ohio

(1)Within twenty business days after a Title IV-E FCM eligible and reimbursable 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 Title IV-E agency will continue to receive FCM reimbursements 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 in the state where the child is placed.

(c)Inform the custodial Title IV-E 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) Ensure the Title XIX medicaid coverage in the Ohio statewide automated child welfare information system (SACWIS) is terminated and 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 for FCM reimbursement.

(3)When the child is no longer eligible for FCM reimbursement, 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 Title IV-E agency from the other state that a FCM eligible and reimbursable 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 Title IV-E 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 FCM, which may include an approved FCM application.

(v)The name, address and phone number of a contact person at the custodial agency in another state with Title IV-E FCM 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 FCM information in Ohio 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 Title IV-E agency.

(d)The Ohio Title IV-E agency must complete the ODM 06612 "Health Insurance Information Sheet" (rev. 9/2016) 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 FCM eligibility from the custodial Title IV-E agency in the state receiving FCM reimbursements on behalf of a child placed in Ohio. Upon notification from the custodial Title IV-E agency that the child does not meet FCM program eligibility and reimbursability criteria, the Ohio Title IV-E agency shall take steps to:

(a)Terminate Title XIX medicaid coverage in Ohio 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 Title IV-E 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 FCM recipient who is placed in Ohio by a custodial Title IV-E agency. At a minimum, the case record shall contain all of the information required in paragraph () (B) of this rule.

(D)A child who is eligible for FCM reimbursement in Ohio shall not be denied Title XIX medicaid coverage if the other state does not make Title XIX medicaid coverage available.

Effective: 7/1/2023

Five Year Review (FYR) Dates: 3/6/2023 and 07/01/2028

Certification: CERTIFIED ELECTRONICALLY

Date: 06/13/2023

Promulgated Under: 119.03

Statutory Authority: 5103.03, 5101.141, 5153.16

Rule Amplifies: 5103.03, 5101.141, 5153.16

Prior Effective Dates: 09/30/1987 (Emer.), 12/27/1987, 05/01/1998, 09/01/2003, 10/08/2007, 06/01/2013, 06/23/2018