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OHCA Policies and Rules

OHCA Policies and Rules Main Page

317:35-5-63 Agency responsible for determination of eligibility

[Revised 09-12-22]

(a) Determination of eligibility by Oklahoma Health Care Authority (OHCA). OHCA is responsible for determining eligibility for the following eligibility groups:

(1) Children;

(2) Newborns deemed eligible;

(3) Pregnant women;

(4) Pregnancy-related services under Title XXI;

(5) Parents and caretaker relatives;

(6) Former foster care children;

(7) Breast and Cervical Cancer (BCC) treatment program;

(8) SoonerPlan family planning program;

(9) Programs of All-Inclusive Care for the Elderly (PACE); and

(10) Expansion adults.

(b) Determination of eligibility by OKDHS. OKDHS is responsible for determining eligibility for the following eligibility groups:

(1) TANF recipients;

(2) Recipients of adoption assistance or kinship guardianship assistance;

(3) State custody;

(4) Refugee medical assistance;

(5) Aged;

(6) Blind;

(7) Disabled;

(8) Tuberculosis;

(9) Qualified Medicare Beneficiary Plus (QMBP);

(10) Qualified Disabled Working Individual (QDWI);

(11) Specified Low-Income Medicare Beneficiary (SLMB);

(12) Qualifying Individual (QI-1);

(13) Long-term care services; and

(14) Alien emergency services.

(c) Determination of eligibility for programs offered through the Health Insurance Exchange. OHCA assesses applicants who are found to be ineligible for SoonerCare for potential eligibility for affordable insurance programs offered through the Health Insurance Exchange. OHCA does not determine eligibility or ineligibility for those programs. OHCA facilitates the determination for those affordable insurance programs by forwarding applicants' electronic applications to the Health Insurance Exchange.

Disclaimer. The OHCA rules found on this Web site are unofficial. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.

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Oklahoma Health Care Authority

4345 N Lincoln Blvd

Oklahoma City, OK 73105

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The Oklahoma Health Care Authority collects the personally identifiable data submitted and received in regard to applications for services, renewals, appeals, provision of health care and processing of claims. This data is treated as confidential and is stored securely in accordance with applicable law and regulations. OHCA may share this personally identifiable data with its authorized business associates, government agencies with jurisdiction over the OHCA, or as otherwise required or permitted by applicable law.