Library: Policy

317:35-5-9. Determining categorical relationship to expansion adults

Revised 9-12-22

(a) To be eligible for SoonerCare under expansion adults, individuals shall meet the following requirements:

(1) Are age nineteen (19) years or older, and under age sixty-five (65);

(2) Are not pregnant;

(3) Are not entitled to or enrolled for Medicare benefits under part A or B;

(4) Are not eligible for SoonerCare in another mandatory eligibility group under Oklahoma's Medicaid State Plan;

(5) Have household income that is at or below 133 percent of the federal poverty level (FPL) for their household size; and

(6) Meet general SoonerCare program eligibility requirements described in Oklahoma Administrative Code (OAC) 317:35, including but not limited to citizenship and residence requirements.

(b) An individual whose household's modified adjusted gross income (MAGI) exceeds the income standard for participation under the parent and caretaker relative group, including those eligible for transitional medical assistance per 317:35-6-64.1, may participate in expansion adults if:

(1) The individual resides with and assumes primary responsibility for the care of a child under nineteen (19) years of age; and

(2) The child is enrolled in SoonerCare or other minimum essential coverage, as described by the Affordable Care Act.