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Library: Policy

317:35-22-1. Pregnancy related benefits covered under Title XXI

Revised 6-25-12

(a) The revision of the definition of child at 42 CFR 457.10, allows states to cover pregnancy related services under Title XXI, individuals who would not otherwise qualify for services under SoonerCare.  This coverage is intended to benefit newborn children who are Oklahoma residents at birth.

(b) To receive pregnancy related services under Title XXI, the pregnant woman must:

  • (1) be otherwise ineligible for any other categorically SoonerCare eligibility group;

  • (2) reside in Oklahoma with the intent to remain, at the time services are rendered;

  • (3) have household income at or below 185% FPL; and

  • (4) not be covered by creditable insurance, the term creditable insurance means coverage under a group health plan or other health insurance as defined in the Health Insurance Portability and Accountability Act (HIPAA).

(c) All services are subject to post payment review by the OHCA or its designated agent.

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