Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 45 - Insure Oklahoma › Subchapter 1 - General Provisions › Section 317:45-1-2 - Program limitations

Current through Vol. 41, No. 20, July 1, 2024
(a) The Insure
				Oklahoma program is contingent upon federal waiver approval and sufficient
				funding that is collected and dispersed through a revolving fund within the
				State Treasury designated as the "Health Employee and Economy Improvement Act
				(HEEIA) Revolving Fund". This fund is a continuing fund, not subject to fiscal
				year limitations.
(1) All monies accruing to
				the credit of the fund are budgeted and expended by the Oklahoma Health Care
				Authority (OHCA) to implement the program.
(2) The program is funded through a portion
				of monthly proceeds from the Tobacco Tax, Title 68 of the Oklahoma Statutes
				(O.S.) §
										302-5
				et seq., collected and dispersed through the HEEIA revolving fund, pursuant to
				68 O.S. §§ 302-5 (B)(1) & (C)(1) and 402-3 (B)(1) &
				(D)(1).
(3) The program is limited
				in scope such that available funding is not exceeded. Available funding
				includes the estimated annual deposits from tax collections, accrued interest,
				federal matching funds and any other revenue source deposited in the HEEIA
				Revolving Fund for the purpose of this program. If at any time it becomes
				apparent there is risk the available funding may be exceeded, OHCA must take
				action to ensure the Insure Oklahoma program continues to operate within its
				fiscal capacity.
(A) Insure Oklahoma may
				limit eligibility based on:
(i) The 1115
				Waiver;
(ii) Tobacco tax
				collections; and
(iii) The State
				Child Health Plan for the State Children's Health Insurance Program (CHIP)
				under Title XXI of the Social Security Act.
(B) The Insure Oklahoma program may limit
				eligibility when the utilization of services is projected to exceed the
				spending authority, or, may suspend new eligibility determinations instead,
				establishing a waiting list.
(i) Applicants,
				not previously enrolled and participating in the program, submitting new
				applications for the Insure Oklahoma program may be placed on a waiting list.
				Applications, with the exception of college students, are identified by region.
				Regions are established based on population density statistics as determined
				through local and national data and may be periodically adjusted to assure
				statewide availability. Insure Oklahoma program size is determined by OHCA and
				may be periodically adjusted.
(ii)
				The waiting list utilizes a "first in - first out" method of selecting eligible
				applicants by region and program.
(iii) When an applicant is determined
				eligible and moves from the waiting list to active participation, the applicant
				must submit a new application.
(iv)
				Enrolled applicants who are currently participating in the program are not
				subject to the waiting list.
(v)
				For approved employers, if the employer hires a new employee after the
				employer's program eligibility begins, the new employee is allowed to
				participate.
(vi) For approved
				employers, if the employer has an employee who has a qualifying event after the
				employer's program eligibility begins, the employee is allowed to make changes
				pertaining to the qualifying event.