HB 130: Regards Medicaid Estate Recovery Program notification requirement
This bill requires the department of medicaid to notify applicants for any medicaid program component about the existence of the medicaid estate recovery program. The department must also notify approved applicants about the program when their application is approved. The department must create two types of notifications: one for consumers to explain how the program functions, including example scenarios, and another for enrollees who may be at risk of being subject to the program that lists available resources for consumer support. The notifications must include specific information, such as the statement that the enrollee's estate may be subject to recovery after death, the types of health care and services subject to the program, and the per member per month capitation payment amount. The department must also create a process for identifying enrollees who may be at risk of being subj…
| May. 14, 2025 | Referred to committee: Medicaid |
| May. 13, 2025 | Introduced |
| May. 07, 2025 | Passed |
| Apr. 09, 2025 | Reported: Medicaid |
| Feb. 26, 2025 | Referred to committee: Medicaid |
As Passed by the House
136th General Assembly
Regular Session
H. B. No. 130
2025-2026
Representatives LaRe, Brennan
Cosponsors: Representatives Gross, Mohamed, White, E., Brewer, Isaacsohn, Baker, Synenberg, Williams, Richardson, Lampton, Mullins, Stephens, Abdullahi, Barhorst, Brent, Brownlee, Click, Cockley, Denson, Glassburn, Grim, Hall, D., Jarrells, Jones, Lear, Lett, Mathews, A., Mathews, T., McNally, Miller, J., Newman, Odioso, Oelslager, Peterson, Piccolantonio, Plummer, Rader, Ray, Robb Blasdel, Robinson, Roemer, Rogers, Russo, Salvo, Schmidt, Sigrist, Somani, Swearingen, Thomas, C., Thomas, D., Tims, Troy, Young
A BILL
To enact section 5162.213 of the Revised Code regarding notification requirements for the Medicaid Estate Recovery Program.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That section 5162.213 of the Revised Code be enacted to read as follows:
Sec. 5162.213.
(A) (1) Upon application, the department of medicaid shall notify each applicant for any medicaid program component subject to the medicaid estate recovery program instituted under section 5162.21 of the Revised Code of the existence of the medicaid estate recovery program, including the information specified in division (B) (1) of this section.
(2) The department of medicaid shall again notify each applicant described in division (A) (1) of this section about the medicaid estate recovery program, including the information specified in division (B) (2) of this section, when the application is approved.
(3) In addition to the notice required by divisions (A) (1) and (2) of this section, the department also shall create both of the following:
(a) A consumer-focused notification that explains in plain language how the medicaid estate recovery program functions, including example scenarios. The department shall engage medicaid consumers to participate in the development and review of the notification and any additional materials that will accompany it.
(b) A notification for medicaid enrollees who may be at risk of being subject to the medicaid estate recovery program that lists available resources for consumer support, such as legal aid and estate planning resources.
(B) The director of medicaid shall adopt rules to ensure compliance with this section, as follows:
(1) The rules shall require the first page of the medicaid application to be a document that includes all of the following information:
(a) A statement that if the enrollee is enrolled in any program described by section 5162.21 of the Revised Code, the enrollee's estate may be subject to recovery after the enrollee's death;
(b) A list of health care and other services to which the medicaid estate recovery program applies;
(c) The per member per month capitation payment, or managed care premium, amount paid by the department to each medicaid managed care organization in the previous calendar year. As used in this division, "capitation payment" has the same meaning as defined in 42 C.F.R. 483.2.
(2) The rules shall require that an approved medicaid eligibility determination notice sent to enrollees as required under 42 C.F.R. 435.917 include both the information required under division (B) (1) of this section and a document that contains the following information:
(a) How to file a complaint with the department regarding the enrollee's medicaid benefits;
(b) How to inquire about the status of medicaid benefits;
(c) How to disenroll from the medicaid program.
(3) The rules shall specify the form and dissemination of the notifications described in division (A) (3) of this section, including a process for identifying medicaid enrollees who may be at risk of being subject to the medicaid estate recovery program. The rules shall be adopted in accordance with Chapter 119. of the Revised Code.