Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 9 - Icf/Iid, Hcbw/Iid, and Individuals Age 65 or Older in Mental Health Hospitals › Part 7 - DETERMINATION OF FINANCIAL ELIGIBILITY › Section 317:35-9-67 - Determining financial eligibility of categorically needy individuals

Current through Vol. 41, No. 20, July 1, 2024
Financial eligibility for ICF/MR, HCBW/MR, and individuals
					 age 65 or older in mental health hospitals medical care for categorically needy
					 individuals is determined as follows:
(1)
Financial eligibility in a Modified
				  Adjusted Gross Income (MAGI) eligibility group.
In determining financial
				  eligibility for an individual related to a group for whom the MAGI methodology
				  is used, rules in Subchapter 6 of this Chapter are followed.
(2)
Financial eligibility/categorically
				  related to ABD.
In determining income and resources for the individual
				  related to ABD, the "family" includes the individual and spouse, if any. To be
				  categorically needy, the individual's countable income must be less than the
				  categorically needy standard as shown on the OKDHS Appendix C-1, Schedule VI.
				  If an individual and spouse cease to live together for reasons other than
				  institutionalization, 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 spouse after the mutual
				  consideration has ended are considered. If the individual and spouse cease to
				  live together because of the individual entering an ICF/MR, see OAC
				  317:35-9-68(a)(3)
				  to determine financial eligibility.
(A) The
				  categorically needy standard on OKDHS Appendix C-1, Schedule VI, is applicable
				  for individuals related to ABD. If the individual is in an ICF/MR and has
				  received services for 30 days or longer, the categorically needy standard in
				  OKDHS Appendix C-1, Schedule VIII. B., is used. If the individual leaves the
				  facility prior to the 30 days, or does not require services past the 30 days,
				  the categorically needy standard on OKDHS Appendix C-1, Schedule VI, is used.
				  The rules on determination of income and resources are applicable only when an
				  individual has entered an ICF/MR and is likely to remain under care for 30
				  consecutive days. The 30-day requirement is considered to have been met even if
				  it is interrupted by a hospital stay or the individual is deceased before the
				  30-day period ends [Refer to OAC
				  317:35-9-68(a)(3)(B)(x)
				  ]. An individual who is a patient in an extended care facility may have SSI
				  continued for a three month period if he/she meets conditions described in
				  Subchapter 5 of this Chapter. The continuation of the payments is intended for
				  use of the member and does not affect the vendor payment. If the institutional
				  stay exceeds the three month period, SSI will make the appropriate
				  change.
(B) In determining
				  eligibility for HCBW/MR services, refer to OAC
				  317:35-9-68(b).
(C) In determining eligibility for
				  individuals age 65 or older in mental health hospitals, refer to OAC
				  317:35-9-68(c).