OhioRISE Eligibility Proposed Rule – OAC 5160-59-02

The Ohio Department of Medicaid (ODM) has proposed revisions to the OhioRISE eligibility rule that would align enrollment timing with managed care by establishing a first-of-month effective date when eligibility criteria are met. The change is intended to improve consistency across Medicaid managed care enrollment processes.

The Ohio Council recently submitted comments on the proposal, focusing on implementation considerations. In our comments, we noted that the first-of-month effective date and retroactive termination provisions may have implications for billing, payment responsibility, and cross-payer coordination when services are delivered earlier in the same month.

We encouraged ODM to provide further guidance to support consistent implementation across plans and providers. The Ohio Council will continue to monitor updates as the rule moves forward.