Library: Policy

317:55-3-1. Mandatory populations

Revised 9-12-22

(a) Mandatory MCO enrollment. Per 56 O.S. ' 4002.3, eligibles in the following categories will be mandatorily enrolled in the MCP and with an MCO:

(1) Expansion adults;

(2) Parents and caretaker relatives;

(3) Pregnant women;

(4) Deemed newborns;

(5) Children; and

(6) All other populations requiring mandatory coverage pursuant to in 42 C.F.R. Part 435, Subpart B ('' 435.100 435.172), unless otherwise covered by SoonerCare.

(b) Mandatory Specialty Children's Plan enrollment. Per 56 O.S. ' 4002.3, eligibles in the following categories, upon entering custody of the State, will be mandatorily enrolled in the MCP and with the MCO under contract to provide the Specialty Children's Plan:

(1) Foster children (FC); and

(2) Certain children in the custody of OJA.

(c) Mandatory Specialty Children's Plan enrollment, opt out. Per 56 O.S. ' 4002.3, eligibles in the following categories will be mandatorily enrolled in the MCP and with the MCO under contract to provide the Specialty Children's Plan, if they do not select a different MCO during initial enrollment, open enrollment, or steady state enrollment:

(1) Former foster care (FFC); and

(2) Children receiving adoption assistance (AA).

(d) Mandatory DBM enrollment. Per 56 O.S. ' 4002.3, the following eligibles will be mandatorily enrolled in the MCP and with a DBM:

(1) Expansion adults;

(2) Parents and caretaker relatives;

(3) Pregnant women;

(4) Deemed newborns;

(5) Former foster children;

(6) Certain children in the custody of OJA;

(7) Foster care children;

(8) Children receiving adoption assistance; and

(9) Children.