Library: Policy

317:35-7-40. Eligibility as Qualified Medicare Beneficiary Plus

Revised 9-14-20

An individual determined to be categorically related to aged, blind or disabled is eligible for Medical Services as a Qualified Medicare Beneficiary Plus (QMBP) if he/she meets the conditions of eligibility shown in paragraphs (1)-(3) of this subsection. • 1  For persons age 65 and older in mental health hospitals, refer to Oklahoma Administrative Code 317:35-9-7.

(1) The individual's income and resources do not exceed the standard as shown on OKDHS Appendix C-1, Schedule VI, of which the income standard is based on 100 percent (100%) of the Federal Poverty Level.For an individual whose spouse is not eligible for Medicare, total countable income of the eligible individual must be equal to or less than the QMBP standards for an individual, and the income of both must be equal to or less than the QMBP standards for a couple.For a couple who are both eligible for Medicare, total countable income must be equal to or less than the QMBP standards for a couple.

(2) Countable income and resources are determined using the same rules followed in determining eligibility for individuals categorically related to Aged, Blind or Disabled, except that a $20 general income disregard is applied to either earned or unearned income, but not both. For couples, only one $20 general income disregard is given.  • 2

(3) The individual meets all other eligibility conditions for SoonerCare.

INSTRUCTIONS TO STAFF 317:35-7-40

Revised 12-15-20

1.The Oklahoma Health Care Authority no longer issues or prints copies of medical identification (ID) cards.  Providers verify a member's eligibility by accessing the Eligibility Verification System, also known as the "Provider Network," at www.okhca.org through the Provider Portal.  When members need a physical card for community resources purposes:

(1) Online Enrollment members may log on to their Online Member Account and print the card; and

(2) Non-Online Enrollment members may contact an Oklahoma Human Services (OKDHS) county office to obtain a printed version of the card.  OKDHS staff enters the member's information into the Eligibility tab on the Medicaid Management Information System (MMIS) Extranet and clicks on the link "Display Member ID Card" to print a copy of the front and back of the medical ID card.    

2. Refer to Oklahoma Administrative Code 317:35-7-38.