Okla. Admin. Code § 340:75-13-80

Current through Vol. 42, No. 4, November 1, 2024

Section 340:75-13-80 - Determination of medical eligibility

(a)Determination of medical assistance eligibility. Determination of eligibility for the state's medical assistance programs is required when a child:

(1) is removed from home and placed in the custody of Oklahoma Human Services (OKDHS) or a federally recognized Indian tribe when the state is paying for the Indian child's care; or

(2) enters state-paid care by signed parental agreement.

(b)Unqualified alien child. A child who is an undocumented or unqualified alien is not eligible for medical assistance except in emergency medical situations, regardless of custody status until the child was lawfully determined to be a permanent resident for five years or otherwise meets federal requirements as a qualified alien per Oklahoma Administrative Code 317:35-5-25.

(c)Child or youth not in OKDHS or tribal custody and medical assistance. An application for medical assistance may be made on behalf of a child or by a youth not in OKDHS or tribal custody.

(1) The child in a family-centered services case meets eligibility requirements based on the family income to qualify for medical assistance.

(2) A youth leaving OKDHS or federally recognized tribal care who is 18 years of age may receive medical assistance. Per the 2014 Affordable Care Act, a youth in OKDHS or tribal custody and out-of-home placement on his or her 18th birthday may be eligible to receive medical benefits until his or her 26th birthday. The youth:

(A) meets eligibility criteria to maintain continuous coverage;

(B) who loses medical coverage may apply online with SoonerCare and receive medical coverage until his or her 26th birthday provided all eligibility requirements are met. OKDHS does not pay for services not covered by the Oklahoma Health Care Authority medical program for the youth; and

(C) receiving Supplemental Security Income applies in the local OKDHS office.

(3) A pregnant youth 18 years of age or older may apply for pregnancy-related services covered under Title XXI.

Okla. Admin. Code § 340:75-13-80

Amended at 10 Ok Reg 3987, eff 7-13-93 (emergency); Amended at 11 Ok Reg 505, eff 11-15-93 (emergency); Amended at 11 Ok Reg 1733, eff 5-12-94; Amended at 19 Ok Reg 2265, eff 6-27-02; 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

Amended by Oklahoma Register, Volume 37, Issue 24, September 1, 2020, eff. 9/15/2020

Amended by Oklahoma Register, Volume 41, Issue 23, August 15, 2024, eff. 9/16/2024