Okla. Admin. Code § 317:35-5-63

Current through Vol. 41, No. 19, June 17, 2024

Section 317:35-5-63 - Agency responsible for determination of eligibility

(a)Determination of eligibility by Oklahoma Health Care Authority (OHCA). OHCA is responsible for determining eligibility for the following eligibility groups:

(1) Children;

(2) Newborns deemed eligible;

(3) Pregnant women;

(4) Pregnancy-related services under Title XXI;

(5) Parents and caretaker relatives;

(6) Former foster care children;

(7) Breast and Cervical Cancer (BCC) treatment program;

(8) SoonerPlan family planning program;

(9) Programs of All-Inclusive Care for the Elderly(PACE); and

(10) Expansion adults.

(b)Determination of eligibility by OKDHS. OKDHS is responsible for determining eligibility for the following eligibility groups:

(1) TANF recipients;

(2) Recipients of adoption assistance or kinship guardianship assistance;

(3) State custody;

(4) Refugee medical assistance;

(5) Aged;

(6) Blind;

(7) Disabled;

(8) Tuberculosis;

(9) Qualified Medicare Beneficiary Plus (QMBP);

(10) Qualified Disabled Working Individual (QDWI);

(11) Specified Low-Income Medicare Beneficiary (SLMB);

(12) Qualifying Individual (QI-1);

(13) Long-term care services; and

(14) Alien emergency services.

(c)Determination of eligibility for programs offered through the Health Insurance Exchange. OHCA assesses applicants who are found to be ineligible for SoonerCare for potential eligibility for affordable insurance programs offered through the Health Insurance Exchange. OHCA does not determine eligibility or ineligibility for those programs. OHCA facilitates the determination for those affordable insurance programs by forwarding applicants' electronic applications to the Health Insurance Exchange.

Okla. Admin. Code § 317:35-5-63

Added at 30 Ok Reg 1209, eff 7-1-13

Amended by Oklahoma Register, Volume 35, Issue 24, September 4, 2018, eff. 9/14/2018

Amended by Oklahoma Register, Volume 37, Issue 24, September 1, 2020, eff. 9/14/2020

Amended by Oklahoma Register, Volume 38, Issue 22, August 2, 2021, eff. 7/1/2021

Amended by Oklahoma Register, Volume 39, Issue 24, September 1, 2022, eff. 9/12/2022