reglab/statecodes huggingface dataset:
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 6 - Soonercare for Pregnant Women and Families With Children › Part 6 - COUNTABLE INCOME FOR MAGI › Section 317:35-6-51 - Exceptions to Internal Revenue Code rules

Current through Vol. 41, No. 20, July 1, 2024
(a) The following sources of income are
				  excluded from household income for SoonerCare eligibility under Modified
				  Adjusted Gross Income (MAGI) , regardless of whether they are included in MAGI
				  in Section 36B of the Internal Revenue Code:
(1) Scholarships, awards, or fellowship
				  grants used for education purposes and not for living expenses; and
(2) The following types of American Indian /
				  Alaska Native income:
(A) Distributions from
				  any property held in trust, subject to Federal restrictions, located within the
				  most recent boundaries of a prior Federal reservation, or otherwise under the
				  supervision of the Secretary of the Interior;
(B) Distributions and payments from rents,
				  leases, rights of way, royalties, usage rights, or natural resource extraction
				  and harvest from:
(i) Rights of ownership or
				  possession in any lands described in Paragraph (a)(2)(A) of this section; or
(ii) Federally protected rights
				  regarding off-reservation hunting, fishing, gathering, or usage of natural
				  resources;
(C)
				  Distributions resulting from real property ownership interests related to
				  natural resources and improvements:
(i)
				  Located on or near a reservation or within the most recent boundaries of a
				  prior Federal reservation; or
(ii)
				  Resulting from the exercise of federally-protected rights relating to such real
				  property ownership interests;
(D) Payments resulting from ownership
				  interests in or usage rights to items that have unique religious, spiritual,
				  traditional, or cultural significance or rights that support subsistence or a
				  traditional lifestyle according to applicable Tribal Law or custom;
(E) Student financial assistance provided
				  under the Bureau of Indian Affairs education programs; and
(F) Distributions from Alaska Native
				  Corporations and Settlement Trusts.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 6 - Soonercare for Pregnant Women and Families With Children › Part 6 - COUNTABLE INCOME FOR MAGI › Section 317:35-6-52 - Adjustments to income

Current through Vol. 41, No. 20, July 1, 2024
Amounts subtracted from gross income to calculate MAGI for
					 a household are defined in Section 36B of the Internal Revenue Code. No other
					 deductions are applicable, except the subtraction of 5 percent from the
					 percentage of FPL as provided in OAC
					 317:35-6-39.
Added at 30 Ok Reg 1209, eff
						7-1-13
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 6 - Soonercare for Pregnant Women and Families With Children › Part 6 - COUNTABLE INCOME FOR MAGI › Section 317:35-6-53 - Determination of current monthly income

Current through Vol. 41, No. 20, July 1, 2024
(a)
Use of current monthly
				  income.
Current monthly income is used in determinations of financial
				  eligibility at application, when a member reports a change in circumstances,
				  and at renewal. See
				  317:35-6-39
				  for potential exceptions.
(b)
Calculation of monthly income.
For computation of monthly income,
				  see OAC
				  317:35-10-26(e).
(c)
Anticipated income.
Income
				  which can reasonably be anticipated to be received is considered to be
				  available for the month its receipt is anticipated.
(d)
Expected changes in income.
Reasonably predictable future increases or decreases in income, such as for
				  contract or seasonal employees, are prorated over the year the income is
				  expected to support the household. The predicted annual amount of the income is
				  divided by 12 to reach the monthly amount.
(e)
Lump sum income.
Whether a
				  particular lump sum is counted in household income depends first on whether the
				  source of the lump sum is a countable source of income according to OAC
				  317:35-6-50
				  and OAC
				  317:35-6-51.
				  See also OAC
				  317:35-10-26 for detailed
				  rules regarding lump sum income.
Added at 30 Ok Reg 1209, eff
						7-1-13
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 6 - Soonercare for Pregnant Women and Families With Children › Part 6 - COUNTABLE INCOME FOR MAGI › Section 317:35-6-54 - Determination of current monthly amount of adjustments to income

Current through Vol. 41, No. 20, July 1, 2024
(a) Expenses or
				  losses that qualify as deductions for MAGI according to OAC
				  317:35-6-52
				  are totaled to reach an annual amount. The annual amount is then divided by 12
				  and subtracted from gross monthly income to calculate the household's current
				  monthly MAGI.
(b) Whether a
				  deduction is allowed when it has already been paid or when it has only been
				  incurred is determined in accordance with Section 36B of the Internal Revenue
				  Code.
Added at 30 Ok Reg 1209, eff
						7-1-13
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 6 - Soonercare for Pregnant Women and Families With Children › Part 6 - COUNTABLE INCOME FOR MAGI › Section 317:35-6-55 - Treatment of qualified lottery or qualified gambling winnings

Current through Vol. 41, No. 20, July 1, 2024
(a)
Definitions.
The following words and terms, when used in this
				  section, shall have the following meaning, unless the context clearly indicates
				  otherwise:
(1)
"Qualified lottery
				  winnings"
means winnings from a sweepstakes, lottery, or pool described
				  in paragraph three (3) of Section 4402 of the Internal Revenue Code of 1986 or
				  a lottery operated by a multistate or multijurisdictional lottery association
				  paid out in a single payout and not in installments over a period of time.
(2)
"Qualified gambling
				  winnings"
means monetary winnings from gambling, as defined by Section
				  (§) 1955(b)(4) of Title 18 of the United States Code (U.S.C.).
(3)
"Undue hardship"
means
				  circumstances resulting from a loss or denial of SoonerCare eligibility that
				  would deprive an individual of medical care, such that the individual's health
				  or life would be endangered, or that would deprive the individual or his or her
				  financially dependent family members of food, clothing, shelter, or other
				  necessities of life.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 6 - Soonercare for Pregnant Women and Families With Children › Part 7 - CERTIFICATION, REDETERMINATION AND NOTIFICATION › Section 317:35-6-60 - Certification for SoonerCare for pregnant women and families with children

Current through Vol. 41, No. 20, July 1, 2024
(a)
General
				  rules of certification.
(1) An
				  individual determined eligible for SoonerCare may be certified for a
				  prospective period of coverage on or after the date of certification.
(2) In accordance with
				  42 Code of Federal
				  Regulations (C.F.R.) §
												435.915 and
				  Oklahoma Administrative Code (OAC)
				  317:35-6-60.2, an individual may
				  also be determined eligible and certified for a retroactive period of coverage
				  during the three (3) month period directly prior to the date of application.
				  This only applies if the individual received covered medical services at any
				  time during that period and would have been eligible for SoonerCare at the time
				  he or she received the services, regardless of whether the individual is alive
				  when application for Medicaid is made. An individual may be eligible for the
				  retroactive period even though ineligible for the prospective period.
(3) The individual who is categorically needy
				  and related to pregnancy-related services retains eligibility for the period
				  covering prenatal, delivery, and postpartum periods without regard to
				  eligibility for other household members in the case. Eligibility during the
				  postpartum period does not apply to women receiving pregnancy-related coverage
				  under Title XXI.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 6 - Soonercare for Pregnant Women and Families With Children › Part 7 - CERTIFICATION, REDETERMINATION AND NOTIFICATION › Section 317:35-6-60.1 - Changes in circumstances

Current through Vol. 41, No. 20, July 1, 2024
(a)
Reporting
				  changes.
Members are required to report changes in their circumstances
				  within ten (10) days of the date the member is aware of the change.
(b)
Agency action on changes in
				  circumstances.
When the agency responsible for determining eligibility
				  for the member becomes aware of a change in the member's circumstances, the
				  agency will promptly redetermine eligibility for all household members whose
				  eligibility is affected by the change.
(c)
Changes reported by third
				  parties.
When the agency receives information regarding a change in the
				  member's circumstances from a third party, such as the Oklahoma Employment
				  Security Commission (OESC) or the Social Security Administration (SSA), the
				  agency will determine whether the information received is reasonably compatible
				  with the most recent information provided by the member.
(1) If the information received is reasonably
				  compatible with the information provided by the member, the agency will use the
				  information provided by the member for determinations and redeterminations of
				  eligibility.
(2) If the information
				  received is not reasonably compatible with the information provided by the
				  member, the agency will determine whether the information received will have an
				  effect on the eligibility of any member of the household.
(A) If the information received has no effect
				  on the eligibility of any member of the household, including the benefit
				  package the member is enrolled in, the agency will take no action.
(B) If the information received has an effect
				  on the eligibility of a member of the household, the agency will request more
				  information from the member, including, but not limited to, an explanation of
				  the discrepancy or verification documenting the correct information regarding
				  the factor of eligibility affected by the information received from a third
				  party.
(C) The agency will give the
				  member proper notice of at least 10 days to respond to the agency's request for
				  information.
(D) If the member does
				  not cooperate in resolving the discrepancy within the timeframe established by
				  the notice, benefits will be terminated.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 6 - Soonercare for Pregnant Women and Families With Children › Part 7 - CERTIFICATION, REDETERMINATION AND NOTIFICATION › Section 317:35-6-60.1 - Changes in circumstances

Current through Vol. 41, No. 20, July 1, 2024
(a)
Reporting changes.
Members are required to report changes in their
				  circumstances within 10 days of the date the member is aware of the
				  change.
(b)
Agency action on
				  changes in circumstances.
When the agency responsible for determining
				  eligibility for the member becomes aware of a change in the member's
				  circumstances, the agency will promptly redetermine eligibility for all
				  household members whose eligibility is affected by the change.
(c)
Changes reported by third
				  parties.
When the agency receives information regarding a change in the
				  member's circumstances from a third party, such as the Oklahoma Employment
				  Security Commission (OESC) or the Social Security Administration (SSA), the
				  agency will determine whether the information received is reasonably compatible
				  with the most recent information provided by the member.
(1) If the information received is reasonably
				  compatible with the information provided by the member, the agency will use the
				  information provided by the member for determinations and redeterminations of
				  eligibility.
(2) If the information
				  received is not reasonably compatible with the information provided by the
				  member, the agency will determine whether the information received will have an
				  effect on the eligibility of any member of the household.
(A) If the information received has no effect
				  on the eligibility of any member of the household, including the benefit
				  package the member is enrolled in, the agency will take no action.
(B) If the information received has an effect
				  on the eligibility of a member of the household, the agency will request more
				  information from the member, including, but not limited to, an explanation of
				  the discrepancy or verification documenting the correct information regarding
				  the factor of eligibility affected by the information received from a third
				  party.
(C) The agency will give the
				  member proper notice of at least 10 days to respond to the agency's request for
				  information.
(D) If the member does
				  not cooperate in resolving the discrepancy within the timeframe established by
				  the notice, benefits will be terminated.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 6 - Soonercare for Pregnant Women and Families With Children › Part 7 - CERTIFICATION, REDETERMINATION AND NOTIFICATION › Section 317:35-6-60.2 - Retroactive eligibility

Current through Vol. 41, No. 20, July 1, 2024
(a) Retroactive
				  eligibility, as outlined in this section, shall be available to pregnant women
				  and/or members under the age of nineteen (19). For retroactive eligibility
				  rules related to other SoonerCare population groups, refer to Oklahoma
				  Administrative Code (OAC)
				  317:35-7-60(b).
(b) In addition to the period of
				  eligibility specified in Oklahoma Administrative Code (OAC)
				  317:35-6-60,
				  an applicant, or individuals within the applicant's household, shall be
				  eligible for SoonerCare benefits up to three (3) months prior to the date of
				  application if all of the following requirements are met:
(1) The individual for whom retroactive
				  coverage is being requested would have been eligible for SoonerCare coverage if
				  an application for SoonerCare had been made during the retroactive month.
(A) The individual does not have to be
				  eligible for the month of application to be found eligible for one (1) of the
				  three (3) retroactive months.
(B)
				  The eligibility factors (e.g. income, residency, household composition, etc.)
				  are evaluated separately for each retroactive month for which retroactive
				  eligibility is being requested.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 6 - Soonercare for Pregnant Women and Families With Children › Part 7 - CERTIFICATION, REDETERMINATION AND NOTIFICATION › Section 317:35-6-61 - Redetermination of eligibility for persons receiving SoonerCare

Current through Vol. 41, No. 20, July 1, 2024
(a) A periodic redetermination of eligibility
				  for SoonerCare is required for all members. The redetermination is made prior
				  to the end of the initial certification period and each twelve (12) months
				  thereafter. A deemed newborn is eligible through the last day of the month the
				  newborn child attains the age of one year, without regard to eligibility of
				  other household members in the case.
(b) Effective January 1, 2014, when the
				  agency has sufficient information available electronically to redetermine
				  eligibility, eligibility will be redetermined on that basis and a notice will
				  be sent to the household explaining the action taken by the agency. The member
				  is responsible for notifying the agency if any information used to redetermine
				  eligibility is incorrect. If the agency does not have sufficient information to
				  redetermine eligibility, the agency will send notice to that effect, and the
				  member is responsible for providing the necessary information to redetermine
				  eligibility.
(c) A member's case is
				  closed if he/she does not return the form(s) and any verification necessary for
				  redetermination timely. If the member submits the form(s) and verification
				  necessary for redetermination within ninety (90) days after closure of the
				  case, benefits are reopened effective the date of the closure, provided the
				  member is eligible and benefits were closed because the redetermination process
				  was not completed.
(d) Effective
				  January 1, 2024, a child who meets the criteria for continuous eligibility
				  shall remain eligible for SoonerCare, until the earlier of:
(1) Twelve (12) months from the effective
				  date of the child's most recent certification period; or
(2) The child's nineteenth
				  (19th) birthday.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 6 - Soonercare for Pregnant Women and Families With Children › Part 7 - CERTIFICATION, REDETERMINATION AND NOTIFICATION › Section 317:35-6-61 - Redetermination of eligibility for persons receiving SoonerCare

Current through Vol. 41, No. 20, July 1, 2024
(a) A periodic
				  redetermination of eligibility for SoonerCare is required for all members. The
				  redetermination is made prior to the end of the initial certification period
				  and each 12 months thereafter. A deemed newborn is eligible through the last
				  day of the month the newborn child attains the age of one year, without regard
				  to eligibility of other household members in the case.
(b) Effective January 1, 2014, when the
				  agency has sufficient information available electronically to redetermine
				  eligibility, eligibility will be redetermined on that basis and a notice will
				  be sent to the household explaining the action taken by the agency. The member
				  is responsible for notifying the agency if any information used to redetermine
				  eligibility is incorrect. If the agency does not have sufficient information to
				  redetermine eligibility, the agency will send notice to that effect, and the
				  member is responsible for providing the necessary information to redetermine
				  eligibility.
(c) A member's case is
				  closed if he/she does not return the form(s) and any verification necessary for
				  redetermination timely. If the member submits the form(s) and verification
				  necessary for redetermination within 90 days after closure of the case,
				  benefits are reopened effective the date of the closure, provided the member is
				  eligible and benefits were closed because the redetermination process was not
				  completed.
(d) Periodic
				  redeterminations scheduled for January to March, 2014 will be rescheduled for
				  April, 2014.
Added at 16 Ok Reg 708, eff 1-1-99 (emergency) ; Added
						at 16 Ok Reg 1438, eff 5-27-99 ; Amended at 21 Ok Reg 2234, eff 6-25-04 ;
						Amended at 23 Ok Reg 268, eff 9-1-05 (emergency) ; Amended at 23 Ok Reg 621,
						eff 12-1-05 (emergency) ; Amended at 23 Ok Reg 1378, eff 5-25-06 ; Amended at
						27 Ok Reg 630, eff 1-14-10 (emergency) ; Amended at 27 Ok Reg 1492, eff 6-11-10
						; Amended at 30 Ok Reg 1209, eff
						7-1-13
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 6 - Soonercare for Pregnant Women and Families With Children › Part 7 - CERTIFICATION, REDETERMINATION AND NOTIFICATION › Section 317:35-6-62 - Notification of eligibility (Renumbered)

Current through Vol. 41, No. 20, July 1, 2024
Added at 16 Ok Reg
					 708, eff 1-1-99 (emergency); Added at 16 Ok Reg 1438, eff 5-27-99; Amended at
					 27 Ok Reg 711, eff 2-4-10 (emergency); Amended at 27 Ok Reg 1471, eff
					 6-11-10
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 6 - Soonercare for Pregnant Women and Families With Children › Part 7 - CERTIFICATION, REDETERMINATION AND NOTIFICATION › Section 317:35-6-62.1 - Electronic Notices (Renumbered)

Current through Vol. 41, No. 20, July 1, 2024
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 6 - Soonercare for Pregnant Women and Families With Children › Part 7 - CERTIFICATION, REDETERMINATION AND NOTIFICATION › Section 317:35-6-63 - Denials

Current through Vol. 41, No. 20, July 1, 2024
If the denial of SoonerCare is for the entire household,
					 the appropriate notice is computer generated to the applicant. If an
					 individual(s) is being denied but other family members are eligible, the denied
					 individual(s) is provided with a notice.
Added at 16 Ok Reg
					 708, eff 1-1-99 (emergency); Added at 16 Ok Reg 1438, eff 5-27-99; Amended at
					 20 Ok Reg 2775, eff 7-1-03 (emergency); Amended at 21 Ok Reg 2234, eff 6-25-04;
					 Amended at 27 Ok Reg 711, eff 2-4-10 (emergency); Amended at 27 Ok Reg 1471,
					 eff 6-11-10
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 6 - Soonercare for Pregnant Women and Families With Children › Part 7 - CERTIFICATION, REDETERMINATION AND NOTIFICATION › Section 317:35-6-64 - Closures

Current through Vol. 41, No. 20, July 1, 2024
SoonerCare cases are closed at any time during the
					 certification period that the case becomes ineligible. A computer-generated
					 notice is sent to the head of the household.
Added at 16 Ok Reg
					 708, eff 1-1-99 (emergency); Added at 16 Ok Reg 1438, eff 5-27-99; Amended at
					 27 Ok Reg 711, eff 2-4-10 (emergency); Amended at 27 Ok Reg 1471, eff
					 6-11-10
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 6 - Soonercare for Pregnant Women and Families With Children › Part 7 - CERTIFICATION, REDETERMINATION AND NOTIFICATION › Section 317:35-6-64.1 - Transitional Medical Assistance (TMA)

Current through Vol. 41, No. 20, July 1, 2024
(a)
Conditions for TMA.
(1)
Transitional Medical
				  Assistance.
Health benefits are continued when the benefit group loses
				  eligibility due to new or increased earnings of the parent(s)/caretaker
				  relative or the receipt of spousal support. The health benefit coverage is of
				  the same amount, duration, and scope as if the benefit group continued
				  receiving SoonerCare. Eligibility for TMA begins with the effective date of
				  case closure or the effective date of closure had the income been reported
				  timely. An individual is included for TMA only if that individual was eligible
				  for SoonerCare and included in the benefit group at the time of the closure. To
				  be eligible for TMA the benefit group must meet all of the requirements listed
				  in (A) - (C) of this paragraph.
(A) At least
				  one member of the benefit group was included in at least three of the six
				  months immediately preceding the month of ineligibility.
(B) The health benefit cannot have been
				  received fraudulently in any of the six months immediately preceding the month
				  of ineligibility.
(C) The benefit
				  group must have included a dependent child who met the age and relationship
				  requirements for SoonerCare and whose needs were included in the benefit group
				  at the time of closure, unless the only eligible child is a Supplemental
				  Security Income (SSI) recipient.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 6 - Soonercare for Pregnant Women and Families With Children › Part 7 - CERTIFICATION, REDETERMINATION AND NOTIFICATION › Section 317:35-6-65 - Transfer of case records between counties

Current through Vol. 41, No. 20, July 1, 2024
Case records on Health Benefits applications, active cases
					 or closed cases are transferred in accordance with OAC
					 340:65.
Added at 16 Ok Reg
					 708, eff 1-1-99 (emergency); Added at 16 Ok Reg 1438, eff
					 5-27-99
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 7 - Medical Services › Part 1 - GENERAL › Section 317:35-7-1 - Scope and applicability

Current through Vol. 41, No. 20, July 1, 2024
The rules in this Subchapter apply when determining
					 eligibility for medical services for children who are reported by OKDHS as
					 being in custody and individuals categorically related to: Aged, Blind and
					 Disabled (ABD); Tuberculosis; SoonerPlan family planning program; Qualified
					 Medicare Beneficiary Plus (QMBP); Qualified Disabled Working Individual (QDWI);
					 Specified Low-Income Medicare Beneficiary (SLMB); Qualifying Individual (QI-1);
					 and TEFRA.
Added at 12 Ok Reg
					 753, eff 1-6-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3133, eff
					 7-27-95; Amended at 14 Ok Reg 56, eff 4-30-96 (emergency); Amended at 14 Ok Reg
					 1802, eff 5-27-97; Amended at 16 Ok Reg 708, eff 1-1-99 (emergency); Amended at
					 16 Ok Reg 1438, eff 5-27-99; Amended at 20 Ok Reg 2775, eff 7-1-03 (emergency);
					 Amended at 21 Ok Reg 2234, eff 6-25-04
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 7 - Medical Services › Part 3 - APPLICATION PROCEDURES › Section 317:35-7-15 - Application for Medical Services; forms [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg 753, eff 1-6-95 through 7-14-95
						(emergency) ; Added at 12 Ok Reg 3133, eff 7-27-95 ; Amended at 14 Ok Reg 56,
						eff 4-30-96 (emergency) ; Amended at 14 Ok Reg 1802, eff 5-27-97 ; Amended at
						16 Ok Reg 708, eff 1-1-97 (emergency) ; Amended at 16 Ok Reg 1438, eff 5-27-99
						; Amended at 18 Ok Reg 114, eff 11-1-00 (emergency) ; Amended at 18 Ok Reg
						1139, eff 5-11-01 ; Amended at 25 Ok Reg 437, eff 11-1-07 (emergency) ; Amended
						at 25 Ok Reg 1227, eff 5-25-08 ; Amended at 27 Ok Reg 711, eff 2-4-10
						(emergency) ; Amended at 27 Ok Reg 1471, eff 6-11-10 ; Amended at 29 Ok Reg
						1160, eff 6-25-12 ; Revoked at 30 Ok Reg 1209, eff
						7-1-13
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 7 - Medical Services › Part 3 - APPLICATION PROCEDURES › Section 317:35-7-16 - Special application procedures for children in OKDHS custody

Current through Vol. 41, No. 20, July 1, 2024
The rules in this section apply when determining
					 eligibility for health benefits for children who are reported by OKDHS as being
					 in custody.
(1) When a child placed in
				  custody as reported by OKDHS remains in the parent's home and there is not an
				  active medical case:
the OKDHS child welfare specialist advises the family of
					 available medical resources and refers the parent(s) to SoonerCare to apply for
					 medical assistance. Application for children receiving Supplemental Security
					 Income must be made in the local OKDHS office.
(2) When a child placed in custody as
				  reported by OKDHS has an active case and a change in placement is made to a
				  home or facility outside the parent's home:
(A) The OKDHS child welfare specialist enters
				  the child's removal information into the Child Abuse and Neglect Information
				  System (KIDS) Removal screen, which generates an assignment to the custody
				  specialist for Title XIX medical benefits.. This referral is made within five
				  working days of the placement.
(B)
				  The OKDHS custody specialist makes the appropriate change to remove the child
				  from the family case and opens a child only case the next effective
				  date.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 7 - Medical Services › Part 3 - APPLICATION PROCEDURES › Section 317:35-7-16 - Special application procedures for children in OKDHS custody

Current through Vol. 41, No. 20, July 1, 2024
The rules in this section apply when determining
					 eligibility for health benefits for children who are reported by OKDHS as being
					 in custody.
(1) When a child placed in
				  custody as reported by OKDHS remains in the parent's home and there is not an
				  active medical case:
(A) The OKDHS child
				  welfare specialist advises the family that an application for medical services
				  may be made at the local OKDHS office.
(B) The OKDHS Family Support Services (FSS)
				  worker is responsible for processing the SC-1, SoonerCare Health Benefits
				  application or FSS-1, Comprehensive Application and Review, whichever is
				  appropriate.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 7 - Medical Services › Part 3 - APPLICATION PROCEDURES › Section 317:35-7-17 - Special application procedures for children in emergency shelters [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg
					 753, eff 1-6-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3133, eff
					 7-27-95; Amended at 14 Ok Reg 6, eff 4-30-96 (emergency); Amended at 14 Ok Reg
					 1802, eff 5-27-97; Revoked at 23 Ok Reg 275, eff 9-1-05 (emergency); Revoked at
					 23 Ok Reg 1387, eff 5-25-06
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 7 - Medical Services › Part 3 - APPLICATION PROCEDURES › Section 317:35-7-18 - Special application procedures for a child in Children's Hospital of Oklahoma (CHO) [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg
					 753, eff 7-14-95 through 1-6-96 (emergency); Added at 12 Ok Reg 3133, eff
					 7-27-95; Amended at 14 Ok Reg 56, eff 4-30-96 (emergency); Amended at 14 Ok Reg
					 1802, eff 5-27-97; Revoked at 16 Ok Reg 708, eff 1-1-99 (emergency); Revoked at
					 16 Ok Reg 1438, eff 5-27-99
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 7 - Medical Services › Part 3 - APPLICATION PROCEDURES › Section 317:35-7-19 - Special application procedures for categorically needy pregnant women and young children [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg
					 753, eff 1-6-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3133, eff
					 7-27-95; Revoked at 14 Ok Reg 56, eff 4-30-96 (emergency); Revoked at 14 Ok Reg
					 1802, eff 5-27-97
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 7 - Medical Services › Part 5 - DETERMINATION OF ELIGIBILITY FOR MEDICAL SERVICES › Section 317:35-7-35 - General eligibility consideration; categorically related family members [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg 753, eff 1-6-95 through 7-14-95
						(emergency) ; Added at 12 Ok Reg 3133, eff 7-27-95 ; Amended at 16 Ok Reg 708,
						eff 1-1-99 (emergency) ; Amended at 16 Ok Reg 1438, eff 5-27-99 ; Revoked at 30
						Ok Reg 1209, eff 7-1-13
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 7 - Medical Services › Part 5 - DETERMINATION OF ELIGIBILITY FOR MEDICAL SERVICES › Section 317:35-7-36 - Financial eligibility of individuals categorically related to ABD

Current through Vol. 41, No. 20, July 1, 2024
In determining financial eligibility for Medical Services
					 for an individual related to ABD, the income and resources of the individual
					 and spouse (if any) are considered. However, consideration is not given to the
					 income and resources of a spouse included in a TANF case. Income of an
					 ineligible spouse may be deemed to the minor dependent child as explained in
					 OAC
					 317:35-7-38(1)(D).
					 The income and resources of a minor dependent child are not considered in
					 determining financial eligibility for the individual related to ABD. The minor
					 dependent child is defined as any biological or adopted child under 18 years of
					 age and residing in the home.
(1) If
				  an individual and spouse cease to live together because of institutionalization
				  or any other reason, income and resources are considered available to each
				  other through the month in which they are separated. Mutual consideration
				  ceases with the month after the month in which the separation occurs. Any
				  amounts which are actually contributed to the eligible individual after the
				  mutual consideration has ended are considered.
(2) If the individual related to Aid to the
				  Blind or Aid to the Disabled is a minor child living in the home of parent(s)
				  or spouse of a parent, the parent'(s) or spouses' income and resources are
				  deemed to the child.
(A) Income is not deemed
				  if the parent or spouse is included in a TANF case or determined categorically
				  needy for Medicaid benefits only. A minor is defined as a child under 18 years
				  and residing in the home. At the point that the minor child no longer resides
				  in the home of the parent(s) or spouse of the parent, the deeming of income and
				  resources ceases with the month after the month of separation. No longer
				  residing in the home includes not only residing in the home of another, but
				  also confinement in a medical facility if the confinement lasts, or is expected
				  to last, 30 days. Any amounts which are actually contributed to the minor child
				  after deeming ends are considered.
(B) For TEFRA children, the income and
				  resources of the parent(s) are not considered.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 7 - Medical Services › Part 5 - DETERMINATION OF ELIGIBILITY FOR MEDICAL SERVICES › Section 317:35-7-37 - Financial eligibility of individuals categorically related to AFDC, or pregnancy-related services [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg 753, eff 1-6-95 through 7-14-95
						(emergency) ; Added at 12 Ok Reg 3133, eff 7-27-95 ; Amended at 13 Ok Reg 911,
						eff 8-1-95 (emergency) ; Amended at 14 Ok Reg 56, eff 4-30-96 (emergency) ;
						Amended at 13 Ok Reg 2537, eff 6-27-96 ; Amended at 14 Ok Reg 1802, eff 5-27-97
						; Amended at 16 Ok Reg 708, eff 1-1-99 (emergency) ; Amended at 16 Ok Reg 1438,
						eff 5-27-99 ; Amended at 19 Ok Reg 136, eff 9-1-01 (emergency) ; Amended at 19
						Ok Reg 2149, eff 6-27-02 ; Amended at 20 Ok Reg 2775, eff 7-1-03 (emergency) ;
						Amended at 21 Ok Reg 2234, eff 6-25-04 ; Amended at 22 Ok Reg 1012, eff 4-1-05
						(emergency) ; Amended at 22 Ok Reg 2518, eff 7-11-05 ; Amended at 29 Ok Reg
						1149, eff 6-25-12 ; Revoked at 30 Ok Reg 1209, eff
						7-1-13
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 7 - Medical Services › Part 5 - DETERMINATION OF ELIGIBILITY FOR MEDICAL SERVICES › Section 317:35-7-38 - Financial eligibility of categorically needy individuals related to ABD

Current through Vol. 41, No. 20, July 1, 2024
(a)
Income
				  and resources below State Supplemental Payment (SSP) standard.
Individuals whose income and resources meet SSP requirements on OKDHS Appendix
				  C-1, Schedules VIII. A. and D., are considered categorically needy.
(1)
Categorical Relationship.
For an individual categorically related to ABD to be categorically needy at the
				  SSP standard, the countable income must be less than the standards on OKDHS
				  Appendix C-1, Schedule VIII. A. and the equity in capital resources cannot
				  exceed the maximum allowable resources on OKDHS Appendix C-1, Schedule VIII. D.
				  for the following groups:
(A) An eligible
				  individual. An eligible individual is a single individual who is aged, blind or
				  disabled and has total countable income less than the "Categorically Needy
				  Standard for an Eligible Individual";
(B) An eligible individual and essential
				  spouse. An essential spouse is defined as having been continuously included in
				  the case since prior to 1974. The total countable income of both must be less
				  than the "Categorically Needy Standard for Eligible Individual with Essential
				  or Ineligible Spouse";
(C) An
				  eligible individual and ineligible spouse. An ineligible spouse does not meet
				  the definition of aged, blind or disabled nor the requirement as "essential".
				  The total countable income of the eligible individual must be less than the
				  "Categorically Needy Standard for Eligible Individual", and the total countable
				  income of both must be less than the "Categorically Needy Standard for Eligible
				  Individual with Essential or Ineligible Spouse";
(D) An eligible individual with a spouse
				  ineligible for ABD and dependent children.
(i) If the spouse and dependent children are
				  included in a TANF diversion payment or ongoing TANF benefits, their income is
				  not deemed to the ABD eligible individual.
(ii) If the spouse's needs are not included
				  in the TANF case for the children, the portion of the spouse's income that is
				  considered in determining the grant for the children is not considered in the
				  SSP case;
(E) An
				  eligible couple. An eligible couple means a husband and wife who are both
				  either aged, blind or disabled and have total countable income less than the
				  "Categorically Needy Standard for Eligible Couple".
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 7 - Medical Services › Part 5 - DETERMINATION OF ELIGIBILITY FOR MEDICAL SERVICES › Section 317:35-7-39 - Financial eligibility of medically needy individuals [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg
					 753, eff 1-6-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3133, eff
					 7-27-95; Amended at 14 Ok Reg 56, eff 4-30-96 (emergency); Amended at 14 Ok Reg
					 1802, eff 5-27-97; Amended at 15 Ok Reg 544, eff 12-1-97 (emergency); Amended
					 at 15 Ok Reg 1554, eff 5-11-98; Amended at 16 Ok Reg 708, eff 1-1-99
					 (emergency); Amended at 16 Ok Reg 1438, eff 5-27-99; Amended at 18 Ok Reg 114,
					 eff 11-1-00 (emergency); Amended at 18 Ok Reg 1139, eff 5-11-01; Revoked at 20
					 Ok Reg 2775, eff 7-1-03 (emergency); Revoked at 21 Ok Reg 2234, eff
					 6-25-04
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 7 - Medical Services › Part 5 - DETERMINATION OF ELIGIBILITY FOR MEDICAL SERVICES › Section 317:35-7-40 - Eligibility as Qualified Medicare Beneficiary Plus

Current through Vol. 41, No. 20, July 1, 2024
An individual determined to be categorically related to
					 aged, blind or disabled is eligible for Medical Services as a Qualified
					 Medicare Beneficiary Plus (QMBP) if he/she meets the conditions of eligibility
					 shown in paragraphs (1)-(3) of this subsection. For persons age 65 and older in
					 mental health hospitals, refer to Oklahoma Administrative Code
					 317:35-9-7.
(1) The individual's income and
				  resources do not exceed the standard as shown on OKDHS Appendix C-1, Schedule
				  VI, of which the income standard is based on 100 percent (100%) of the Federal
				  Poverty Level. For an individual whose spouse is not eligible for Medicare,
				  total countable income of the eligible individual must be equal to or less than
				  the QMBP standards for an individual, and the income of both must be equal to
				  or less than the QMBP standards for a couple. For a couple who are both
				  eligible for Medicare, total countable income must be equal to or less than the
				  QMBP standards for a couple .
(2)
				  Countable income and resources are determined using the same rules followed in
				  determining eligibility for individuals categorically related to Aged, Blind or
				  Disabled, except that a $20 general income disregard is applied to either
				  earned or unearned income, but not both. For couples, only one $20 general
				  income disregard is given.
(3) The
				  individual meets all other eligibility conditions for SoonerCare.
Added at 12 Ok Reg
					 753, eff 1-6-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3133, eff
					 7-27-95; Amended at 14 Ok Reg 56, eff 4-30-96 (emergency); Amended at 14 Ok Reg
					 1802, eff 5-27-97; Amended at 15 Ok Reg 3679, eff 5-18-98 (emergency); Amended
					 at 16 Ok Reg 708, eff 1-1-99 (emergency); Amended at 16 Ok Reg 1438, eff
					 5-27-99; Amended at 18 Ok Reg 114, eff 11-1-00 (emergency); Amended at 18 Ok
					 Reg 1139, eff 5-11-01
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 7 - Medical Services › Part 5 - DETERMINATION OF ELIGIBILITY FOR MEDICAL SERVICES › Section 317:35-7-41 - Eligibility as Qualified Disabled and Working Individual

Current through Vol. 41, No. 20, July 1, 2024
(a) An individual determined to be
				  categorically related to Aid to the Blind or Disabled is eligible for Medicaid
				  as a Qualified Disabled and Working Individual (QDWI) if the following
				  eligibility conditions are met.
(1) Social
				  Security disability benefits were terminated solely due to excess
				  earnings.
(2) Countable income and
				  resources do not exceed the standards as shown on DHS Appendix C-1, Schedule V,
				  in which the income standards are based on 200% of the Federal Poverty
				  Level.
(3) Medicaid eligibility
				  cannot be established under QMB or categorically needy programs.
(4) Individual is enrolled in Medicare Part
				  A.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 7 - Medical Services › Part 5 - DETERMINATION OF ELIGIBILITY FOR MEDICAL SERVICES › Section 317:35-7-42 - Presumptive eligibility for pregnant women [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg
					 753, eff 1-6-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3133, eff
					 7-27-95; Amended at 14 Ok Reg 56, eff 4-30-96 (emergency); Amended at 14 Ok Reg
					 1802, eff 5-27-97; Revoked at 16 Ok Reg 708, eff 1-1-99 (emergency); Revoked at
					 16 Ok Reg 1438, eff 5-27-99
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 7 - Medical Services › Part 5 - DETERMINATION OF ELIGIBILITY FOR MEDICAL SERVICES › Section 317:35-7-43 - Eligibility as Specified Low-Income Medicare Beneficiaries

Current through Vol. 41, No. 20, July 1, 2024
An individual determined to be categorically related as
					 aged, blind or disabled is eligible as a Specified Low-Income Medicare
					 Beneficiary (SLMB) if he/she meets the conditions of eligibility in paragraphs
					 (1) and (2) of this Section. For persons age 65 and older in mental health
					 hospitals, refer to OAC
					 317:35-9-7.
(1) The individual is enrolled for Medicare
				  hospital insurance benefits under Part A, which includes an individual entitled
				  to hospital insurance benefits by reason of voluntary enrollment in the
				  premium-paying Part A program.
(2)
				  The individual's income and resources do not exceed the standard as shown on
				  DHS Appendix C-1, Schedule VII, of which the income standard is based on 120%
				  of the Federal Poverty Level. State Supplemental Payments are not considered
				  when determining the countable income. For an individual whose spouse is not
				  eligible for Medicare, total countable income of the eligible individual must
				  be equal to or less than the SLMB standards for an individual and the income of
				  both must be equal to or less than the SLMB standards for a couple. For a
				  couple who are both eligible for Medicare, total countable income must be equal
				  to or less than the SLMB standards for a couple. Countable income and resources
				  are determined using the same rules followed in determining eligibility for
				  individuals categorically related to Aid to the Aged, Blind or Disabled, except
				  that a $20 general income disregard is also applied to either earned or
				  unearned income, but not both. For couples, only one $20 general income
				  disregard is given.
Added at 12 Ok Reg
					 753, eff 1-6-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3133, eff
					 7-27-95; Amended at 14 Ok Reg 56, eff 4-30-96 (emergency); Amended at 14 Ok Reg
					 1802, eff 5-27-97; Amended at 15 Ok Reg 3679, eff 5-18-98 (emergency); Amended
					 at 16 Ok Reg 708, eff 1-1-99 (emergency); Amended at 16 Ok Reg 1438, eff
					 5-27-99
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 7 - Medical Services › Part 5 - DETERMINATION OF ELIGIBILITY FOR MEDICAL SERVICES › Section 317:35-7-44 - Eligibility for TB related services

Current through Vol. 41, No. 20, July 1, 2024
(a) An individual determined to be
				  categorically related to disability because of TB is eligible for limited
				  Medicaid benefits if he/she meets the conditions of eligibility shown in
				  paragraphs (1)-(4) of this subsection.
(1)
				  Must have verification of active TB infection from a medical
				  practitioner;
(2) Countable income
				  (earned and unearned) must be less than the categorically needy standards shown
				  on DHS Appendix C-1, Schedule XIII. The income standard is based on the
				  break-even point which is described in the Social Security Procedure/Operations
				  Manual (POMS-SI 00810.350).
(3)
				  Equity in capital resources cannot exceed the maximum allowable resources on
				  DHS Appendix C-1, Schedule XIII. which is the allowable SSI resource standard
				  for an individual.
(4) The
				  individual meets all other eligibility conditions for Medicaid.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 7 - Medical Services › Part 5 - DETERMINATION OF ELIGIBILITY FOR MEDICAL SERVICES › Section 317:35-7-45 - Eligibility for catastrophic illness [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 14 Ok Reg 56,
					 eff 4-30-96 (emergency); Added at 14 Ok Reg 538, eff 12-24-96 (emergency);
					 Added at 14 Ok Reg 1814, eff 5-27-97; Amended at 16 Ok Reg 708, eff 1-1-99
					 (emergency); Amended at 16 Ok Reg 1438, eff 5-27-99; Revoked at 20 Ok Reg 2775,
					 eff 7-1-03 (emergency); Revoked at 21 Ok Reg 2234, eff
					 6-25-04