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 7 - APPLICATION AND ELIGIBILITY DETERMINATION PROCEDURES › Section 317:35-5-60 - Application for SoonerCare; forms

Current through Vol. 41, No. 20, July 1, 2024
(a)
Application.
An application for medical services consists of the
				  SoonerCare application. The application form is signed by the individual,
				  parent, spouse, guardian or someone else acting on the individual's behalf. An
				  individual does not have to have received a medical service nor expect to
				  receive one to be certified for SoonerCare. The application form is available
				  as an online application, as a paper form, and is available to be completed by
				  telephone with the assistance of the agency.
(1) An application may be made in a variety
				  of locations, for example, a physician's office, a hospital or other medical
				  facility or in the county OKDHS office. An application may be made online by
				  individuals who are pregnantor have children or are applying for family
				  planning services only. A face-to-face interview is not required. Only
				  SoonerCare applications for women who are pregnant, and families with children
				  and for family planning services are mailed to the OHCA Eligibility Unit.
				  Applications for other medical services may be mailed or faxed to the local
				  county OKDHS office. If faxed, it is not necessary to send the original
				  application. When an individual indicates a need for health benefits, the
				  physician or facility may forward an application or 08MA005E to the OKDHS
				  county office of the patient's residence for processing. The physician or
				  facility may forward an application or OKDHS form 08MA005E for individuals who
				  are pregnantor have children or are applying for family planning services only
				  to the OHCA Eligibility Unit for processing. If the applicant is unable to sign
				  the application, someone acting on his/her behalf may sign the application. An
				  application for SoonerCare may also be submitted through the Health Insurance
				  Exchange.
(2) OKDHS form 08MA005E,
				  Notification of Needed Medical Services, is required only for preauthorization
				  of medical services. Although not required, the form may be submitted by the
				  physician or facility as notification of a need for medical services. The form
				  also may be accepted as medical verification of pregnancy.
(3) Receipt of the SoonerCare Application
				  form or OKDHS form 08MA005E constitutes an application for
				  SoonerCare.
(4) If OKDHS form
				  08MA005E is received and an application cannot be completed, receipt of OKDHS
				  form 08MA005E constitutes an application which must be registered and
				  subsequently denied. The applicant and provider are notified by
				  computer-generated notice.
(5) If
				  the applicant also wishes to apply for a State Supplemental Payment, either the
				  applicant or his/her guardian must sign the Medical Assistance Application
				  form.