Library: Policy

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

Revised 9-12-22

(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.