Okla. Admin. Code § 340:75-13-75

Current through Vol. 42, No. 7, December 16, 2024

Section 340:75-13-75 - Out-of-state Medicaid coverage

(a)Title IV-E eligible. A child certified for Title IV-E in Oklahoma is eligible for Title XIX Medicaid coverage in the child's state of residence when the child is placed in an out-of-state Interstate Compact on the Placement of Children placement, receiving state, with relatives or non-relatives.

(1) The child continues to receive Title XIX Medicaid coverage from the state of residence when the Title IV-E foster care eligibility remains in effect.

(2) A medical plan that provides necessary and expected medical services and payment for those services must be in place before the child in Oklahoma Department of Human Services (OKDHS) custody is sent to reside out-of-state.

(b)Medicaid and Title IV-E ineligible child. A child ineligible for Title IV-E may be eligible for Medicaid from the receiving state, depending on that state's eligibility criteria.

(1) When the receiving state does not provide Medicaid for a child in OKDHS custody who is ineligible for Title IV-E:

(A) the Oklahoma medical case remains open; and

(B) the placement provider in the receiving state locates all medical providers the child may need who:

(i) are Oklahoma Medicaid providers; or

(ii) may become Oklahoma Medicaid providers.

(2) The Oklahoma Health Care Authority (OHCA) assists providers from other states to become Oklahoma Medicaid providers.

(c)Out-of-state medical services. A child in OKDHS custody requiring medical attention while traveling through or vacationing in another state must receive the needed emergency care. When the medical provider is:

(1) an Oklahoma Medicaid provider, the provider files a claim;

(2) not an Oklahoma Medicaid provider, but is willing to become one, the provider is referred to the OHCA Provider Contract; or

(3) not an Oklahoma Medicaid provider and is not willing to become one, the CW specialist contacts Operations and Business Processes Section for assistance to pay for the medical service provided to the child.

(d)Medical expenses when a child is placed with a parent. When a child in OKDHS custody is placed with a parent, the parent is responsible for the child's medical expenses.

(1) The parent may apply for medical assistance for the child in the parent's state of residence.

(2) The child may receive medical coverage from the receiving state when the family meets that state's eligibility requirements.

Okla. Admin. Code § 340:75-13-75

Amended at 16 Ok Reg 102, eff 10-13-98 (preemptive); Amended at 22 Ok Reg 854, eff 5-12-05; Amended at 24 Ok Reg 1323, eff 6-1-07; Amended at 28 Ok Reg 894, eff 7-1-11; Amended at 29 Ok Reg 635, eff 6-1-12; Amended at 30 Ok Reg 839, eff 7-1-13

AGENCY NOTE: ¹ The second set of paragraphs (1) and (2) under subsection (a) should have been promulgated under subsection (b).