Medicare AdvantageReimbursementMedium impact
5160-1-05.1 - Payment for "Medicare Part C" cost sharing. (New/Final File)
Ohio Medicaid·OH·Reimbursement
Effective date
Jul 1, 2023
We identified it
Jun 20, 2026
Summary
Ohio Department of Medicaid has updated Rule 5160-1-05.1 regarding payment for Medicare Part C (Medicare Advantage) cost sharing. This is a recent policy rescission and replacement that became effective July 1, 2023, affecting how Medicaid handles cost sharing for dual-eligible patients with Medicare Advantage plans.
Action Required
Billing team should review current dual-eligible Medicare Advantage patient accounts to ensure proper cost sharing billing procedures align with updated Ohio Medicaid requirements. Contact Ohio Department of Medicaid at 614-752-3877 for specific implementation guidance if treating dual-eligible patients in Ohio.