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Ohio Rev. Code Ann. § 5160.31

Appeals regarding determination of eligibility for medical assistance program

Applied in 2 court decisions — leading case Small World Early Childhood Ctr. v. Ohio Dept. of Job & Family Servs. (2017)

Most recently applied in State ex rel. Small World Early Learning Ctr. v. Ohio Dept. of Job & Family Servs. (October 2019)

Effective: September 29, 2013; Latest Legislation: House Bill 59 - 130th General Assembly

(A) A medical assistance recipient may appeal a decision regarding the recipient's eligibility for a medical assistance program or services available to the recipient under a medical assistance program.

(B) Regarding appeals authorized by this section, the department of medicaid shall do one or more of the following:

(1) Administer an appeals process similar to the appeals process established under section 5101.35 of the Revised Code;

(2) Contract with the department of job and family services pursuant to section 5162.35 of the Revised Code to provide for the department of job and family services to hear the appeals in accordance with section 5101.35 of the Revised Code;

(3) Delegate authority to hear appeals to an exchange or exchange appeals entity.

(C) If a medical assistance recipient files an appeal as authorized by this section, the department of medicaid may do either or both of the following:

(1) Take corrective action regarding the matter being appealed before a hearing decision regarding the matter is issued;

(2) If a hearing decision, administrative appeal decision, or court ruling is against the recipient, take action in favor of the recipient despite the contrary decision or ruling, unless, in the case of a court's ruling, the ruling prohibits the department from taking the action.

Official source: Ohio Laws & Administrative Rules (Legislative Service Commission). Reproduced from public-domain Ohio statutes; confirm against the official source for the current text. Not legal advice.