OHCA Policies and Rules
317:35-9-1. Overview of long-term medical care services; relationship to QMB, SLMB, and other Medicaid services eligibility, and spenddown calculation
[Revised 05-19-25]
(a) Long-term medical care for the categorically needy includes:
(1) Care in a nursing facility, per Oklahoma Administrative Code (OAC) 317:35-19;
(2) Public and private intermediate care facility for individuals with intellectual disabilities, per OAC 317:35-9;
(3) Persons age sixty-five (65) years or older in mental health hospitals, per OAC 317:35-9;
(4) Home and Community Based Waiver Services for the Intellectually Disabled, per OAC 317:35-9;
(5) Home and Community Based Waiver Services for the ADvantage program, per OAC 317:35-17; and
(6) State Plan Personal Care provides services, per OAC 317:35-15.
(b) Any time an individual is certified as eligible for long-term care SoonerCare coverage, the individual is also eligible for other SoonerCare services. Another application or additional spenddown computation is not required. Spenddown is applied to the first long-term care claim filed. Any time an aged, blind or disabled individual is determined eligible for long-term care, a separate determination is made to see if eligibility conditions as a QMB or SLMB are met. Another application for QMB or SLMB benefits is not required. Any spenddown computed for long-term care is not applicable to QMB or SLMB coverage.
(c) The State of Oklahoma operates a Medicaid program to recover cost for services identified in OAC 317:35-9-15.
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.
