Library: Policy

340:75-13-80. Determination of medical eligibility

Revised 9-14-24

(a) Determination of medical assistance eligibility. Determination of eligibility for the state's medical assistance programs is required when a child:

(1) is removed from home and placed in the custody of Oklahoma Human Services (OKDHS) or a federally recognized Indian tribe when the state is paying for the Indian child's care; or

(2) enters state-paid care by signed parental agreement. • 1

(b) Unqualified alien child. A child who is an undocumented or unqualified alien is not eligible for medical assistance except in emergency medical situations, regardless of custody status until the child was lawfully determined to be a permanent resident for five years or otherwise meets federal requirements as a qualified alien per Oklahoma Administrative Code 317:35-5-25. • 2

(c) Child or youth not in OKDHS or tribal custody and medical assistance. An application for medical assistance may be made on behalf of a child or by a youth not in OKDHS or tribal custody. • 3

(1) The child in a family-centered services case meets eligibility requirements based on the family income to qualify for medical assistance.

(2) A youth leaving OKDHS or federally recognized tribal care who is 18 years of age may receive medical assistance. Per the 2014 Affordable Care Act, a youth in OKDHS or tribal custody and out-of-home placement on his or her 18th birthday may be eligible to receive medical benefits until his or her 26th birthday. The youth:

(A) meets eligibility criteria to maintain continuous coverage;

(B) who loses medical coverage may apply online with SoonerCare and receive medical coverage until his or her 26th birthday provided all eligibility requirements are met. OKDHS does not pay for services not covered by the Oklahoma Health Care Authority medical program for the youth; and

(3) A pregnant youth 18 years of age or older may apply for pregnancy-related services covered under Title XXI.

INSTRUCTIONS TO STAFF 340:75-13-80

Revised 9-14-24

1. Medical assistance eligibility determination.

(1) Within two-business days of the child's removal from the home, the child welfare (CW) specialist per Oklahoma Administrative Code (OAC) 340:75-3-300 ITS 10(6):

(A) completes a search of the child and family's Oklahoma Human Services (OKDHS) history through the Information Management System (IMS);

(B) opens a KK case and enters all available information in the KK case;

(C) uploads the court order that documents the child's removal from the home into the KIDS document management system (DMS) no later than 15-business days following the hearing; and

(D) provides the child's Social Security number or uploads proof of application receipt into the KIDS (DMS) to verify the application was submitted, per OAC 340:75-13-10.

(2) The custody specialist:

(A) certifies the eligible child on a C, H, or J case in Family Assistance/Client Services (FACS) system effective, the:

(i) first-calendar day of the month of the child's removal from the home;

(ii) date Form 04FC007E, Authorization from Parent or Guardian for Voluntary Foster Home Placement and Medical Care of Child, or Form 04IL001E, Voluntary Placement Request, as applicable, was signed;

(B) removes the child from any other medical case and updates those cases on FACS with custody information; and

(C) uploads Form 04KI072E, Medical Eligibility Determination, from KIDS, signs, and files in KIDS DMS.

(3) Each child's medical case is reviewed every 12 months, per OAC 317:35-7-62.

(A) When a review of the medical case is due, the custody specialist reviews information from the KIDS case and IMS programs and applications; and:

(i) verifies the child remains in custody and in an out-of-home placement;

(ii) checks PY screens and updates income if necessary;

(iii) updates review information in FACS and enters a case note documenting that the review was completed and the child remains in custody and in an out-of-home placement; and

(iv) uploads a digitally signed ED screen into the Child Welfare Services (CWS) medical review section of KIDS DMS reflecting that the review was completed.

(B) The CW specialist immediately notifies the custody specialist via email when:

(i) OKDHS or a tribe no longer has custody of the child; and

(ii) there are changes in the child's:

(I) type of placement;

(II) county of residence;

(III) benefits; or

(IV) health insurance coverage.

(4) The medical case for a child in OKDHS or tribal paid care is retained in the county of the assigned custody specialist.

2. Acquiring medical or dental care or prescriptions for the undocumented alien child. When an undocumented alien child in OKDHS custody in out-of-home placement:

(1) requires an emergency procedure, the CW specialist consults the custody specialist regarding submission of required documentation to Oklahoma Health Care Authority (OHCA) for approval; or

(2) receives routine medical services, the CW specialist obtains a completed claim from the medical provider and notes undocumented alien child and the child's KK number on the claim and forwards the claim to CWS Finance and Business (FB).

(A) When the undocumented alien child requires medical, dental, vision, or mental health services, the CW specialist mails the original claim form to CWS FB with a coversheet including the:

(i) child's name;

(ii) KK number; and

(iii) child's undocumented alien status.

(B) When the undocumented alien child requires prescriptions, the original pharmacy labeling information receipt is mailed to CWS FB with a coversheet that includes the:

(i) child's name;

(ii) KK number; and

(iii) child's undocumented alien status.

3. Medicaid certification for former foster care youth. A youth aging out of foster care is certified for Medicaid without an application or required review. Changes in address or other demographics are reported by the youth to OHCA.