Library: Policy

317:35-15-6. Determining financial eligibility of categorically needy individuals

Revised 9-12-22

        Financial eligibility for State Plan Personal Care (SPPC) services for categorically needy individuals is determined as follows:

(1) Financial eligibility for Modified Adjusted Gross Income (MAGI) eligibility groups. See MAGI eligibility rules in Subchapter 6 of this Chapter to determine financial eligibility.

(2) Financial eligibility or categorically related to Aged, Blind, and Disabled. In determining income and resources for the member related to ABD, the "family" includes the individual and spouse, if any. To be categorically needy, the countable income is less than the categorically needy standard as shown on the OKDHS form 08AX001E (Appendix C-1), Schedule VI Qualified Medicare Beneficiary Plus standard. If a member and his or her spouse cease to live together for reasons other than institutionalization or receipt of a Home and Community Based Waiver, ADvantage or Developmental Disabilities services, 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 to the spouse after the mutual consideration has ended are considered.

(3) Determining financial eligibility for State Plan Personal Care (SPPC). For individuals determined categorically needy for SPPC, the member will not pay a vendor payment for SPPC services.