340:65-5-3. Benefit suspension and resolution
(a) State Supplemental Payment (SSP) and SoonerCare (Medicaid) benefits may be suspended when the Social Security Administration (SSA) suspends the recipient's Supplemental Security Income (SSI) until the SSI benefit is reinstated or closed. • 1
(b) Sooner Care (Medicaid) may be suspended when: • 2
(1) SSA suspends the recipient's SSI until the SSI benefit is reinstated or closed;
(2) the recipient is incarcerated, for the duration of the incarceration period, per Oklahoma Administrative Code (OAC) 317:35-6-45; or
(3) the Oklahoma Health Care Authority initiates an administrative sanction until the sanction is removed, per OAC 317:35-13-7; or
(4) Form 08TA018E, Continued Medical Benefit Reply Form, is not received timely for households who are eligible for a continued medical benefit (CMB) following a Temporary Assistance for Needy Families benefit closure due to earnings. When the worker does not reinstate CMB by the suspension month's advance notice deadline, per OKDHS Appendix B-2, Deadlines for Case Actions, CMB automatically closes effective the next month, per OAC 340:10-3-75.
(c) Following suspension, when the recipient is determined: • 3
(1) eligible, the worker reinstates the benefit effective the month the benefit was suspended;
(2) eligible for the month following the suspension month, the worker recertifies the benefit effective the next month; or
(3) ineligible for the benefit, the worker closes the benefit effective the next month.
INSTRUCTIONS TO STAFF 340:65-5-3
1. (a) Temporary Assistance for Needy Families (TANF), Supplemental Nutrition Assistance Program food benefits, and Child Care Subsidy benefits are not suspended.
(b) When the worker determines the recipient remains eligible for the State Supplemental Payment (SSP) and SoonerCare (Medicaid) benefit, the worker reinstates benefits and makes any appropriate changes at the same time. The worker uses the F17C process to issue SSP payments that are due.
2. The worker documents the suspension reason in Family Assistance/Client Services (FACS) case notes.
3. The worker documents the basis for reinstating, recertifying, or closing the benefit in FACS case notes.