Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 5 - Eligibility and Countable Income › Part 1 - DETERMINATION OF QUALIFYING CATEGORICAL RELATIONSHIP › Section 317:35-5-2 - Categorically related programs

Current through Vol. 41, No. 20, July 1, 2024
(a) In order to be
				  eligible for SoonerCare, an individual must first meet the description of a
				  member eligibility group.
(1) For individuals
				  related to the aged, blind, or disabled groups, categorical relationship is
				  established using the same definitions of age, disability, and blindness as
				  used by the Social Security Administration (SSA) in determining eligibility for
				  Supplemental Security Income (SSI) or SSA benefits.
(2) If the individual is a SSA/SSI recipient
				  in current payment status (including presumptive eligibility), a Temporary
				  Assistance for Needy Families (TANF) recipient, an adoption assistance or
				  kinship guardianship assistance recipient, or is under age nineteen (19),
				  categorical relationship is automatically established.
(3) For individuals related to expansion
				  adults the categorical relationship is established and defined by
				  42 Code of Federal
				  Regulations (C.F.R.) §
												435.119.
(4) Categorical relationship to the pregnancy
				  group is established when the determination is made by medical evidence that
				  the individual is or has been pregnant. Verification of pregnancy is only
				  required if the individual's declaration that she is pregnant is not reasonably
				  compatible with other information available to the agency. Pregnancy-related
				  services include all medical services provided within the scope of the program
				  during the prenatal, delivery and postpartum periods for women in this
				  pregnancy group; see Subchapter 22 of this Chapter for services for unborn
				  children covered under Title XXI.
(5) For an individual age nineteen (19) or
				  over to be related to the parent and caretaker relative group, the individual
				  must have a minor dependent child.
(6) For an individual to be related to the
				  former foster care children group, the individual must have been receiving
				  Medicaid benefits as a foster care child in Oklahoma or another state when
				  he/she attained the age of eighteen (18), or aged out of foster care, until
				  he/she reaches the age of twenty-six (26). If the individual aged out of foster
				  care in a state other than Oklahoma, the date of ageing out had to occur on
				  January 1, 2023, or later, and the individual must now be residing in Oklahoma.
				  There is no income or resource test for the former foster care children group.
(7) Categorical relationship to
				  refugee services is established in accordance with OAC
				  317:35-5-25.
(8) Categorical relationship for the Breast
				  and Cervical Cancer (BCC) treatment program is established in accordance with
				  Subchapter 21 of this Chapter.
(9)
				  Categorical relationship for the SoonerPlan family planning program is
				  established in accordance with OAC
				  317:35-5-8.
(10) Categorical relationship for pregnancy
				  related benefits covered under Title XXI is established in accordance with
				  Subchapter 22 of the Chapter. Benefits for pregnancies covered under Title XXI
				  medical services are provided within the scope of the program during the
				  prenatal, delivery and postpartum care when included in the global delivery
				  payment.