NON-APA WF 18-R

COMMENT DUE DATE:

December 21, 2018

DATE:

December 12, 2018

Laura Brown AFS 405-521-4396

Dena Thayer, Programs Administrator 405-521-4326

Nancy Kelly, Policy Specialist 405-522-6703

RE:

NON-APA WF 18-R

It is very important that you provide your comments regarding the DRAFT COPY of policy by the comment due date. Comments are directed to *STO.LegalServices.Policy@okdhs.org.

The proposed policy is Non-APA . This proposal is not subject to Administrative Procedures Act

It is important that you provide your comments regarding the draft copy of policy by the comment due date.Comments are directed to STO.LegalServices.Policy@okdhs.org.These changes are amendments to Instructions to Staff (ITS).

SUBJECT:Chapter 35. Medical Assistance for Adults and Children

Subchapter 5. Eligibility and Countable Income

Part 3. Non-Medical Eligibility Requirements

OAC 317:35-5-25 [Amended[

Part 5. Countable Income and Resources

OAC 317:35-5-41.2 [Amended]

OAC 317:35-5-41.6 [Amended]

OAC 317:35-5-42 [Amended]

Subchapter 7. Medical Services

Part 5. Determination Of Eligibility For Short-Term Medical Services

OAC 317:35-7-40 [Amended]

Subchapter 9. ICF/IID, HCBW/IID, And Individuals 65 Or Older In Mental Hospitals

Part 9. Certification, Redetermination And Notification

OAC 317:35-9-75 [Amended]

Subchapter 15. Personal Care Services

OAC 317:35-15-7 [Amended]

Subchapter 17. Advantage Waiver Services

OAC 317:35-17-12

Subchapter 19. Nursing Facility Services

OAC 317:35-19-22

(WF 18-R)

SUMMARY:

317:35-5-25 Instructions to staff is amended to:(1) clarify information needed when requesting an emergency medical services decision; (2) add information needed to request a categorical relationship decision; and add a rule citation.

317:35-5-41.2, 317:35-5-41.6, and 317:35-5-42 Instructions to staff are amended to:(1) add the name of the Oklahoma Achieving a Better Life Experience (ABLE) Program in Oklahoma and how it is administered; and (2) update the annual current gift tax exclusion amount and the maximum an an ABLE account.

317:35-7-40, 317:35-9-75, 317:35-15-7, 317:35-17-12, and 317:35-19-22 are amended to add instructions for printing medical card information now that the Oklahoma Health Care Authority no longer issues plastic medical cards.

SUBCHAPTER 5.Eligibility and Countable Income

PART 3. NON-MEDICAL ELIGIBILITY REQUIREMENTS

317:35-5-25. Citizenship/alien status and identity verification requirements

Revised 9-14-18

(a) Citizenship/alien status and identity verification requirements. Verification of citizenship/alien status and identity are required for all adults and children approved for SoonerCare. An exception is individuals who are initially eligible for SoonerCare as deemed newborns; according to Section 1903(x) of the Social Security Act, they will not be required to further document citizenship or identity at any subsequent SoonerCare eligibility redetermination. They are considered to have provided satisfactory documentation of citizenship and identity by virtue of being born in the United States.

(1) The types of acceptable evidence that verify identity and citizenship include:

(A) United States (U.S.) Passport; ¢ 1

(B) Certificate of Naturalization issued by U.S. Citizenship & Immigration Services (USCIS)(Form N-550 or N-570);

(D) Copy of the Medicare card or printout of a BENDEX or SDX screen showing receipt of Medicare benefits, Supplemental Security Income or disability benefits from the Social Security Administration; or ¢ 2

(E) Tribal membership card or Certificate of Degree of Indian Blood (CDIB) card, with a photograph of the individual.

(2) The types of acceptable evidence that verify citizenship but require additional steps to obtain satisfactory evidence of identity are listed in subparagraphs (A) and (B). Subparagraph (A) lists the most reliable forms of verification and is to be used before using items listed in (B). Subparagraph (B) lists those verifications that are less reliable forms of verification and are used only when the items in (A) are not attainable.¢ 3

(A) Most reliable forms of citizenship verification are:

(i) A U.S. public Birth Certificate showing birth in one of the 50 states, the District of Columbia, Puerto Rico (on or after 1/13/1941), Guam (on or after 4/10/1899), the U.S. Virgin Islands (on or after 1/17/1917), American Samoa, Swain's Island, or the Northern Mariana Islands after 11/4/1986. For Puerto Ricans whose eligibility is being determined for the first time on or after October 1, 2010 and using a birth certificate to verify citizenship, the birth certificate must be a certified birth certificate issued by Puerto Rico on or after July 1, 2010;

(ii) A Report of Birth Abroad of a U.S. citizen issued by the Department of Homeland Security or a Certification of birth issued by the State Department (Form FS-240, FS-545 or DS-1350);

(iii) A U.S. Citizen ID Card (Form I-179 or I-197);

(iv) A Northern Mariana Identification Card (Form I-873) (Issued by the INS to a collectively naturalized citizen of the U.S. who was born in the Northern Mariana Islands before 11/3/1986);

(v) An American Indian Card issued by the Department of Homeland Security with the classification code "KIC" (Form I-872);

(vi) A Final Adoption Decree showing the child's name and U. S. place of birth;

(vii) Evidence of U.S. Civil Service employment before 6/1/1976;

(viii) An Official U.S. Military Record of Service showing a U.S. place of birth (for example a DD-214);

(ix) Tribal membership card or Certificate of Degree of Indian Blood (CDIB) card, without a photograph of the individual, for Native Americans;

(x) Oklahoma Voter Registration Card; or

(xi) Other acceptable documentation as approved by OHCA.

(B) Other less reliable forms of citizenship verification are:

(i) An extract of a hospital record on hospital letterhead established at the time of the person's birth that was created five years before the initial application date and that indicates a U.S. place of birth. For children under 16 the evidence must have been created near the time of birth or five years before the date of application;

(ii) Life, health, or other insurance record showing a U.S. place of birth that was created at least five years before the initial application date and that indicates a U.S. place of birth;

(iii) Federal or State census record showing U.S. citizenship or a U.S. place of birth (generally for persons born 1900 through 1950). The census record must also show the applicant's/member's age; or

(iv) One of the following items that show a U.S. place of birth and was created at least five years before the application for SoonerCare. This evidence must be one of the following and show a U.S. place of birth:

(I) Seneca Indian tribal census record;

(II) Bureau of Indian Affairs tribal census records of the Navajo Indians;

(III) U.S. State Vital Statistics official notification of birth registration;

(IV) An amended U.S. public birth record that is amended more than five years after the person's birth; or

(V) Statement signed by the physician or midwife who was in attendance at the time of birth.

(3) Acceptable evidence of identity that must accompany citizenship evidence listed in (A) and (B) of paragraph (2) of this subsection includes:

(A) A driver's license issued by a U.S. state or territory with either a photograph of the individual or other identifying information such as name, age, sex, race, height, weight, or eye color;

(B) A school identification card with a photograph of the individual;

(C) An identification card issued by Federal, state, or local government with the same information included on driver's licenses;

(D) A U.S. military card or draft record;

(E) A U.S. military dependent's identification card;

(F) A Native American Tribal document including Certificate of Degree of Indian Blood, or other U.S. American Indian/Alaska Native Tribal document with a photograph of the individual or other personal identifying information;

(G) A U.S. Coast Guard Merchant Mariner card;

(H) A state court order placing a child in custody as reported by the OKDHS;

(I) For children under 16, school records may include nursery or daycare records;

(J) If none of the verification items on the list are available, an affidavit may be used for children under 16. An affidavit is only acceptable if it is signed under penalty of perjury by a parent or guardian stating the date and place of the birth of the child and cannot be used if an affidavit for citizenship was provided.

(b) Reasonable opportunity to obtain citizenship verification.

(1) When the applicant/member is unable to obtain citizenship or alienage verification, a reasonable opportunity is afforded to the applicant/member to obtain the evidence as well as assistance in doing so. A reasonable opportunity is afforded to the applicant/member before taking action affecting the individual's eligibility for SoonerCare. The reasonable opportunity timeframe afforded to SoonerCare members is the same as authorized under Section 1902(ee) of the Social Security act and is stated on the documentation request the agency sends to the applicant/member.

(2) The following methods of verification are the least reliable forms of verification and should only be used as a last resort:

(A) Institutional admission papers from a nursing facility, skilled care facility or other institution. Admission papers generally show biographical information for the person including place of birth; the record can be used to establish U.S. citizenship when it shows a U.S. place of birth;

(B) Medical (clinic, doctor, or hospital) record created at least five (5) years before the initial application date that indicates a U.S. place of birth. For children under the age of sixteen (16), the document must have been created near the time of birth. Medical records generally show biographical information for the person including place of birth; the record can be used to establish U.S. citizenship when it shows a U.S. place of birth. An immunization record is not considered a medical record for purposes of establishing U.S. citizenship;

(C) Written affidavit. Affidavits are only used in rare circumstances. If the verification requirements need to be met through affidavits, the following rules apply:

(i) There must be at least two affidavits by two (2) individuals who have personal knowledge of the event(s) establishing the applicant's/member's claim of citizenship;

(ii) At least one (1) of the individuals making the affidavit cannot be related to the applicant/member;

(iii) In order for the affidavit to be acceptable, the persons making them must be able to provide proof of their own citizenship and identity;

(iv) the individual(s) making the affidavit has information which explains why evidence establishing the applicant's/member's claim of citizenship does not exist or cannot be readily obtained, the affidavit must contain this information as well;

(v) The State must obtain a separate affidavit from the applicant/member or other knowledgeable individual (guardian or representative) explaining why the evidence does not exist or cannot be obtained; and

(vi) The affidavits must be signed under penalty of perjury.

(c) Alienage verification requirements. SoonerCare services are provided as listed to the defined groups as indicated in this subsection if they meet all other factors of eligibility. ¢ 4Persons determined as having lawful alien status must have the status verified through Systematic Alien Verification for Entitlement (SAVE).

(1) Eligible aliens (qualified aliens). The groups listed in the following subparagraphs are eligible for the full range of SoonerCare services. A qualified alien is:

(A) an alien who was admitted to the United States and has resided in the United States for a period greater than five (5) years from the date of entry and who was:

(i) lawfully admitted for permanent residence under the Immigration and Nationality Act;

(ii) paroled into the United States under Section 212(d)(5) of such Act for a period of at least one (1) year;

(iii) granted conditional entry pursuant to Section 203(a)(7) of such Act as in effect prior to April 1, 1980; or

(iv) a battered spouse, battered child, or parent or child of a battered person with a petition under 204(a)(1)(A) or (B) or 244(a)(3) of the Immigration and Naturalization Act.

(B) an alien who was admitted to the United States and who was:

(i) granted asylum under Section 208 of such Act regardless of the date asylum is granted;

(ii) a refugee admitted to the United States under Section 207 of such Act regardless of the date admitted;

(iii) an alien with deportation withheld under Section 243(h) of such Act regardless of the date deportation was withheld;

(iv) a Cuban or Haitian entrant as defined in Section 501(e) of the Refugee Education Assistance Act of 1980, regardless of the date of entry;

(v) an alien who is a veteran as defined in 38 U.S.C. § 101, with a discharge characterized as an honorable discharge and not on the grounds of alienage;

(vi) an alien who is on active duty, other than active duty for training, in the Armed Forces of the United States;

(vii) the spouse or unmarried dependent child of an individual described in (C) of this paragraph;

(viii) a victim of a severe form of trafficking pursuant to Section 107(b) of the Trafficking Victims Protection Act of 2000; or

(ix) admitted as an Amerasian immigrant.

(C) permanent residents who first entered the country under (B) of this paragraph and who later converted to lawful permanent residence status.

(2) Other aliens lawfully admitted for permanent residence (non-qualified aliens). Non-qualified aliens are those individuals who were admitted to the United States and who do not meet any of the definitions in paragraph (1) of this subsection. Non-qualified aliens are ineligible for SoonerCare for five (5) years from the date of entry except that non-qualified aliens are eligible for emergency services only when the individual has a medical condition (including emergency labor and delivery) with acute symptoms which may result in placing his/her health in serious jeopardy, serious impairment to bodily functions or serious dysfunction of body organ or part without immediate medical attention, in accordance with 317:30-3-32. The only exception is when a pregnant woman qualifies under the pregnancy related benefits covered under the Title XXI program because the newborn child will meet the citizenship requirement at birth.

(3) Afghan Special Immigrants. Afghan special immigrants, as defined in Public Law 110-161, who have special immigration status after December 26, 2007, are exempt from the five (5) year period of ineligibility for SoonerCare services. All other eligibility requirements must be met to qualify for SoonerCare services. If these individuals do not meet one of the categorical relationships, they may apply and be determined eligible for Refugee Medical Assistance. Afghan special immigrants are considered lawful permanent residents.

(4) Iraqi Special Immigrants. Iraqi special immigrants, as defined in Public Law 110-181, who have special immigration status after January 28, 2008, are exempt from the five (5) year period of ineligibility for SoonerCare services. All other eligibility requirements must be met to qualify for SoonerCare services. If these individuals do not meet one of the categorical relationships, they may apply and be determined eligible for Refugee Medical Assistance. Iraqi special immigrants are considered lawful permanent residents.

(5) Undocumented aliens. Undocumented aliens who do not meet any of the definitions in (1)-(2) of this subsection are eligible for emergency services only when the individual has a medical condition (including emergency labor and delivery) with acute symptoms which may result in placing his/her health in serious jeopardy, serious impairment to bodily functions or serious dysfunction of body organ or part without immediate medical attention, in accordance with 30-3-32. The only exception is when a pregnant woman qualifies under the pregnancy related benefits covered under the Title XXI program because the newborn child will meet the citizenship requirement at birth.¢ 5

(6) Ineligible aliens.

(A) Ineligible aliens who do not fall into the categories in (1) and (2) of this subsection, yet have been lawfully admitted for temporary or specified periods of time include, but are not limited to: foreign students, visitors, foreign government representatives, crewmen, members of foreign media and temporary workers including agricultural contract workers. This group is ineligible for SoonerCare, including emergency services, because of the temporary nature of their admission status. The only exception is when a pregnant woman qualifies under the pregnancy related benefits covered under the Title XXI program because the newborn child will meet the citizenship requirement at birth.

(B) These individuals are generally issued Form I-94, Arrival Departure Record, on which an expiration date is entered. This form is not the same Form I-94 that is issued to persons who have been paroled into the United States. Parolees carry a Form I-94 that is titled "Arrival-Departure Record B Parole Edition". Two other forms that do not give the individual "Immigrant" status are Form I-186, Nonresident Alien Mexican Border Crossing Card, and Form SW-434, Mexican Border Visitors Permit.

(d) Alienage. A decision regarding eligibility cannot be made until the eligibility condition of citizenship and alienage is determined.

(1) Immigrants. Aliens lawfully admitted for permanent residence in the United States are classified as immigrants by the USCIS. These are individuals who entered this country with the express intention of residing here permanently.

(2) Parolees. Under Section 212(d)(5) of the Immigration and Nationality Act, individuals can be paroled into the United States for an indefinite or temporary period at the discretion of the United States Attorney General. Individuals admitted as Parolees are considered to meet the "citizenship and alienage" requirement.

(3) Refugees and Western Hemisphere aliens. Under Section 203(a)(7) of the Immigration and Nationality Act, Refugees and Western Hemisphere aliens may be lawfully admitted to the United States if, because of persecution or fear of prosecution due to race, religion, or political opinion, they have fled from a Communist or Communist-dominated country or from the area of the Middle East; or if they are refugees from natural catastrophes. These entries meet the citizenship and alienage requirement. Western Hemisphere aliens will meet the citizenship requirement for SoonerCare if they can provide either of the documents in subparagraphs (A) and (B) of this paragraph as proof of their alien status.

(A) Form I-94 endorsed "Voluntary Departure Granted-Employment Authorized", or

(B) The following court-ordered notice sent by USCIS to each of those individuals permitted to remain in the United States: "Due to a Court Order in Silva vs. Levi, 76 C4268 entered by District Judge John F. Grady in the District Court for the Northern District of Illinois, we are taking no action on your case. This means that you are permitted to remain in the United States without threat of deportation or expulsion until further notice. Your employment in the United States is authorized".

(4) Special provisions relating to Kickapoo Indians. Kickapoo Indians migrating between Mexico and the United States carry Form I-94, Arrival-Departure Record (Parole Edition). If Form I-94 carries the statement that the Kickapoo is "paroled pursuant to Section 212(d)(5) of the Immigration and Nationality Act" or that the "Kickapoo status is pending clarification of status by Congress" regardless of whether such statements are preprinted or handwritten and regardless of a specific mention of the "treaty", they meet the "citizenship and alienage" requirement. All Kickapoo Indians paroled in the United States must renew their paroled status each year at any local Immigration Office. There are other Kickapoos who have entered the United States from Mexico who carry Form I-151 or Form I-551, Alien Registration Receipt Cards. These individuals have the same status as other individuals who have been issued Form I-151 or Form I-551 and, therefore, meet the citizenship and alienage requirements. Still other Kickapoos are classified as Mexican Nationals by the USCIS. They carry Form I-94, Arrival-Departure Record, which has been issued as a visiting visa and does not make mention of the treaty. Such form does not meet the "citizenship and alienage" requirements but provides only the ineligible alien status described in (c)(4)(b) of this Section.¢ 6

(5) American Indians born in Canada. An American Indian born in Canada, who has maintained residence in the United States since entry, is considered to be lawfully admitted for permanent residence if he/she is of at least one-half (1/2) American Indian blood. This does not include the non-citizen whose membership in an Indian tribe or family is created by adoption, unless such person is of at least fifty(50) percent or more Indian blood. The methods of documentation are birth or baptismal certificate issued on a reservation, tribal records, letter from the Canadian Department of Indian Affairs, or school records.

(6) Permanent non-immigrants. Marshall Islanders and individuals from the Republic of Palau and the Federated States of Micronesia are classified as permanent non-immigrants by USCIS. They are eligible for emergency services only, in accordance with 30-3-32.

INSTRUCTIONS TO STAFF 317:35-5-25

Revised ~~9-1-15~~12-1-18

1.A United States (U.S.) passport does not have to be currently valid to be accepted as evidence of U.S. citizenship~~, as long as~~when it was originally issued without limitation.NOTE:spouses and children were sometimes included on one passport through 1980.U.S. passports issued after 1980 show only one person.Consequently, the citizenship and identity of the included person can be established when one of these passports is presented.EXCEPTION: Do not accept any passport as evidence of U.S. citizenship when it was issued with a limitation.However, such a passport may be used as proof of identity.

2.Medicare and SSI recipients do not have to verify their citizenship and identity as they ~~have previously been~~were verified by ~~SSA~~the Social Security Administration.

3.When a person in the online enrollment population provides verification, the worker updates Agency View to show verification was received, images the document, and documents receipt of the verification in case notes.When the person does not have a case number or case record with the Oklahoma Department of Human Services ~~(OKDHS)~~, the worker sends the verification to the Oklahoma Health Care Authority (OHCA) and does not update Agency View.

4.~~See OKDHS Appendix J, Citizenship and Alienage.~~Refer to Oklahoma Administrative Code 340:65-3-4 regarding Systematic Alien Verification for Entitlement

5.(a) When all other eligibility factors ~~have been~~are determined but prior to ~~the case being certified~~certifying medical benefits, the ~~following information must be sent~~the worker sends a memo to OHCA, ~~ATTN~~Attention: Level of Care Evaluation Unit (LOCEU)~~for~~to request a determination onof eligibility for emergency medical services.The memo includes the:

(1) client's name,;

(2) client's Social Security number, ifwhen available,;

(3) client identification number,;

(4) date of the medical service; and

(5) medical ~~records~~information, such as a history and physical, and a discharge summary.

(b) When a categorical relationship decision is needed, the worker also sends a completed Form 08MA022E, Medical Social Summary to LOCEU.LOCEU staff first makes a decision regarding categorical relationship.When the decision is favorable, LOCEU staff then makes a separate decision regarding emergency services.

6.Verification issued by the Department of Homeland Security will identify U.S. citizen members of the Texas Band of Kickapoo Indians living near the U.S./Mexican border.

PART 5.COUNTABLE INCOME AND RESOURCES

317:35-5-41.2. Miscellaneous Personal property¢ 1

Revised 9-1-15

(a) Property used to produce goods and services.Personal property necessary to perform daily activities or to produce goods for home consumption is excluded if the equity value does not exceed $6,000. An equity value in excess of $6,000 is a countable resource.The property does not have to produce a 6% annual return. The $6,000 equity maximum includes all such resources in total and does not pertain to each item separately.Examples of property used to produce goods and services are tractors, wildcatting tools, mechanized equipment for gardening, livestock grown for home consumption, etc.

(b) Cash savings and bank accounts.Money on hand or in a savings account is considered as a countable resource. Verification of the member's countable income or resources held in bank accounts or at other financial institutions can be established through an Asset Verification System (AVS). Title 56, O.S., Section 1671 provides that financial records obtained for the purpose of establishing eligibility for assistance or services must be furnished without cost to the member or the Agency.¢ 2

(1) Checking accounts may or may not represent savings.Current bank statements are evaluated with the member to establish what, if any, portion of the account represents savings. Any income which has been deposited during the current month is not considered unless it exceeds what is considered as ordinary maintenance expense for the month.

(2) Accounts which are owned jointly by the member and a person not receiving SoonerCare are considered available to the member in their entirety unless it can be established what part of the account actually belongs to each of the owners and the money is actually separated and the joint account dissolved.¢ 3When the member is in a nursing facility and the spouse is in the home or if both are institutionalized, a joint bank account may be maintained with one-half of the account considered available to each.

(c) Life insurance policies. If the total face value of all life insurance policies owned by an individual is $1,500 or less, the policies (both face value and cash surrender value) are excluded as resources. Verification of the member's countable income or resources held in bank accounts or at other financial institutions can be established through an AVS.

(1) If the total face value of all policies owned by an individual exceeds $1,500, the net cash surrender value of such policies must be counted as resources.Life insurance policies which do not provide a cash surrender value (e.g., term insurance) are not used in determining whether the total face value of all policies is over $1,500.

(2) The face value of a life insurance policy which has been assigned to fund a prepaid burial contract must be evaluated and counted according to the policy on burial funds or, if applicable, the policy on the irrevocable burial contract.

(3) The net cash surrender value of insurance (i.e., cash surrender value less any loans or unpaid interest thereon) usually can be verified by inspection of the insurance policies and documents in the member's possession or by use of the OKDHS Form 08MP061E, Request to Insurance Company.

(4) Dividends which accrue and which remain with the insurance company increase the amount of resource.Dividends which are paid to the member are considered as income if the life insurance policy is not an excluded resource.

(5) If an individual has a life insurance policy which allows death benefits to be received while living, and the individual meets the insurance company's requirements for receiving such proceeds, the individual is not required to file for such proceeds.However, if the individual does file for and receive the benefits, the payment will be considered as income in the month it is received and countable as a resource in the following months to the extent it is available.The payment of such benefits is not considered a conversion of a resource because the cash surrender value of the insurance policy is still available to the individual.The individual is in effect, receiving the death benefits and not the cash surrender value.

(d) Burial spaces.The value of burial spaces for an individual, the individual's spouse or any member of the individual's immediate family will be excluded from resources."Burial spaces" means conventional grave sites, crypts, mausoleums, urns, and other repositories which are customarily and traditionally used for the remains of deceased persons. "Immediate family" means the individual's minor and adult children, including adopted children and step-children; and the individual's brothers, sisters, parents, adoptive parents, and the spouse of these individuals.Neither dependency nor living in the same household will be a factor in determining whether a person is an immediate family member. Verification of the member's countable income or resources held in bank accounts or at other financial institutions can be established through an AVS.

(e) Burial funds.Revocable burial funds not in excess of $1,500 are excluded as a resource if the funds are specifically set aside for the burial arrangements of the individual or the individual's spouse. ¢ 4Any amount in excess of $1,500 is considered as a resource. Burial policies which require premium payments and do not accumulate cash value are not considered to be prepaid burial policies. Verification of the member's countable income or resources held in bank accounts or at other financial institutions can be established through the AVS.

(1) "Burial funds" means a prepaid funeral contract or burial trust with a funeral home or burial association which is for the individual's or spouse's burial expenses.

(2) The face value of a life insurance policy, when properly assigned by the owner to a funeral home or burial association, may be used for purchasing "burial funds" as described in (1) of this subsection. The $1,500 burial fund exclusion must also be reduced by the face value of a life insurance policy for which a funeral provider has been made the irrevocable beneficiary, if the life insurance policy owner has irrevocably waived his or her right to, and cannot obtain, any cash surrender value the life insurance policy may generate.¢ 5

(3) The burial fund exclusion must be reduced by the face value of life insurance policies owned by the individual or spouse; and amounts in an irrevocable trust or other irrevocable arrangement. ¢ 5

(4) Interest earned or appreciation on the value of any excluded burial funds is excluded if left to accumulate and become a part of the burial fund.

(5) If the member did not purchase his/her own prepaid burial, even if his/her money was used for the purchase, the member is not the "owner" and the prepaid burial funds cannot be considered a resource to him/her.However, if the member's money was used by another to purchase the prepaid burial, the rules on transfer of property must be applied since the purchaser (owner) could withdraw the funds any time.

(f) Irrevocable burial contract. Oklahoma law provides that a purchaser (buyer) of a prepaid funeral contract may elect to make the contract irrevocable.The irrevocability cannot become effective until 30 days after purchase.For an irrevocable contract to be valid, the election to make it irrevocable must be made by the purchaser (owner) or the purchaser's guardian or an individual with power of attorney for the purchaser (owner).¢ 6In instances where the OKDHS Form 08MA084E, Management of Recipient's Funds, is on file in the nursing facility, the form serves as a power of attorney for the administrator to purchase and/or elect to make irrevocable the burial funds for the member. Verification of the member's countable income or resources held in bank accounts or at other financial institutions can be established through an AVS.

(1) The irrevocable contract shall not be considered a countable resource. ¢ 7

(2) Effective October 1, 2015, the cash value of any life insurance policies and/or designated accounts shall be excluded as a resource up to a maximum of $1,500. This exclusion shall be reduced dollar for dollar by the face value amount of any irrevocable prepaid burial contract. ¢ 8

(g) Medical insurance.If a member is covered by insurance other than SoonerCare, then SoonerCare is the payer of last resort and should not be billed until all other payers have paid.If payment is made directly to the member, the member must reimburse OHCA up to the amount paid by SoonerCare.Any amount remaining after payment to OHCA is considered as an available resource.

INSTRUCTIONS TO STAFF 317:35-5-41.2

Revised ~~3-15-17~~12-1-18

1.(a) Effective October 1, 2015, Oklahoma became a Supplemental Security Income (SSI) criteria state.As such, when the individual receives SSI and applies only for Medicaid benefits, the worker is not responsible for verifying the individual's resource eligibility unless he or she provides questionable information.This may occur when the individual reports owning property or liquid resources in excess of the applicable resource standard per Appendix C-1, Maximum Income, Resource, and Payment Standards.

(b) The worker must verify resource eligibility when the individual applies for a State Supplemental Payment.

2.(a) The individual's statement that he or she does not have money on hand or in a financial institution is sufficient unless there are contrary indications.When there is contrary information or the individual does not have records to verify the amount in a financial institution, the worker obtains verification from the financial institution, when not verified through the Oklahoma Health Authority (OHCA) Asset Verification System (AVS) per (b) of this Instruction.

(b) Staff may verify account information at financial institutions electronically through OHCA AVS.When the account is verified through OHCA AVS additional verification is not needed, unless different than normal deposits and withdrawals are seen.When the account is not verified through OHCA AVS, the worker may verify account information by requesting the individual:

(1) provide his or her account statement; or

(2) sign Form 08AD060E, Request for Release of Information, addressed to the designated financial institution, to authorize release of account information.

(c) Per Section 4001.1 of Title 56 of the Oklahoma Statutes (56 O.S. § 4001.1) money and assets in an individual savings or trust account owned by the designated beneficiary of the account and established to pay qualified disability expenses is excluded per the Oklahoma Achieving a Better Life Experience (ABLE) Program or an ABLE program in any other state for the purpose of determining eligibility to receive, or the amount of any assistance or benefits, from local or state means-tested programs.An individual may only have one ABLE account.The individual must provide documents to verify that the account meets exemption criteria before the funds are exempted from resource and income consideration.

(1) The Oklahoma State Treasurer is responsible for certifying an ABLE account.The program name is Oklahoma STABLE.The program is administered through a partnership with Ohio's STABLE Accounts which are backed by Intuition ABLE Solutions, LLC.Rules regarding an ABLE account include:

(A) only individuals whose disability was established before 26 years of age can set up ABLE Act accounts and one account is allowed per individual;

(B) there is no limit to the number of persons who can contribute to the ABLE account; and

(C) upon the death of an ABLE Act participant, every dollar remaining in the account must be paid to the state Medicaid agency to repay costs of care received by the individual during life, up to the amount Medicaid paid.

(2) At application and renewal, the individual must provide proof from the financial institution of the dates and amounts of money deposited into and withdrawn from the ABLE account in the last 12 months.

(A) The exemption from income and resource consideration applies to money deposited in the account up to the annual federal gift tax exclusion per Section 2503(b) of Title 26 of the United States Code.The current gift tax exclusion amount is ~~$14,000~~$15,000 per calendar year.Any money deposited in the account in a calendar year that is in excess of the annual federal gift tax exclusion is considered as countable income in the month deposited and as a resource for the following month.The maximum balance in the ABLE account is $300,000.

(B) When money is withdrawn to pay qualified disability expenses, the amount withdrawn is excluded from income or resource consideration.

(i) The individual must verify, preferably from the financial institution, that the withdrawn funds were used for qualified disability expenses.

(ii) Funds withdrawn and not used for qualified disability expenses are considered as income for the month of withdrawal.

(3) Qualified disability expenses means, any expenses related to the eligible individual's blindness or disability and approved under Section 529A of the Internal Revenue Code that are made for the benefit of an eligible individual who is the designated beneficiary including, but not limited to, expenses for:

(A) education;

(B) housing;

(C) transportation;

(D) employment, training, and support;

(E) assistive technology and personal support services;

(F) health, prevention and wellness, financial management, and administrative expenses;

(G) legal fees;

(H) oversight and monitoring; and

(I) funeral and burial expenses.

3.(a)This is also applicable when both account owners receive SoonerCare.The money in the account is a countable resource.

(b) When the individual dissolves the account as soon as notified, eligibility is not affected.

(c) When both account holders receive SSI, they may share a joint account.The worker only considers each individual’s share of the account in determining his or her eligibility.

4.Examples of funds set aside for burial may include savings or checking accounts, a certificate of deposit, or cash, when the money is clearly designated as being set aside for the individual’s burial.

5.The individual cannot receive athe $1,500 revocable burial fund exclusion and an irrevocable prepaid burial fund exclusion.For example, when an individual has revocable burial funds of $4,500 and does not have other funds set aside for burial, the worker considers $3,000 of the cash value as a countable resource.

6.Per the Oklahoma State Insurance Commission, a funeral home cannot be the beneficiary of a life insurance policy used to fund a burial contract.When the individual uses life insurance to fund a burial contract, there must be an irrevocable agreement between the individual and the insurance company.This is in addition to the prepaid burial contract that must also be irrevocable.

7.There is no maximum face value to receive the irrevocable prepaid burial policy or contract exclusion.While it is irrevocable, it is excluded.

8.All life insurance policies must be considered in determining the amount that must be counted toward the resource limit.A life insurance policy that has a face value less than $1,500 cannot have a separate exemption per (c) of this Section.For example, when the individual has life insurance with a cash value of:

(1) $1,500 and ~~he or she~~ has an irrevocable prepaid burial policy with a face value of $10,000, the worker considers the $1,500 cash value life insurance policy as a countable resource;

(2) $5,500 and an irrevocable prepaid burial policy with a face value of $10,000, the worker considers the $5,500 life insurance as a countable resource. In this example, the individual is not resource eligible for SSP, but meets resource standards for Qualified Medicare Beneficiary Plus benefits, when this is the only resource; or

(3) $750, a second life insurance policy with a cash value of $500, and an irrevocable prepaid burial policy with a face value of $15,000, the $1,250 in cash value life insurance is a countable resource and the irrevocable prepaid burial is excluded.

317:35-5-41.6. Trust accounts

Revised 9-14-18

Monies held in trust for an individual applying for or receiving SoonerCare must have the availability of the funds determined. Funds held in trust are considered available when they are under the direct control of the individual or his/her spouse, and disbursement is at their sole discretion. Funds may also be held in trust and under the control of someone other than the individual or his/her spouse, such as the courts, agencies, other individuals, or the Bureau of Indian Affairs (BIA).

(1) Availability determinations. The worker should be able to determine the availability of a trust using the definitions and explanations listed in (2) of this subsection. However, in some cases, the worker may wish to submit a trust to the Oklahoma Department of Human Services (OKDHS) State Office for determination of availability. In these instances, all pertinent data is submitted to Family Support Services Division, Attention: Health Related and Medical Services Section, for a decision.

(2) Definition of terms. The following words and terms, when used in this paragraph, have the following meaning, unless the context clearly indicates otherwise:

(A) Beneficiary. Beneficiary means the person(s) who is to receive distributions of either income or principal, or on behalf of whom the trustee is to make payments.

(B) Corpus/principal. Corpus/principal means the body of the trust or the original asset used to establish the trust, such as a sum of money or real property.

(C) Discretionary powers. Discretionary powers means the grantor gives the trustee the power to make an independent determination whether to distribute income and/or principal to the beneficiary(ies) or to retain the income and add it to the principal of the trust.

(D) Distributions. Distributions means payments or allocations made from the trust from the principal or from the income produced by the principal (e.g., interest on a bank account).

(E) Grantor (trustor/settlor). Grantor (trustor/settlor) means the individual who establishes the trust by transferring certain assets.

(F) Irrevocable trust. Irrevocable trust means a trust in which the grantor has expressly not retained the right to terminate or revoke the trust and reclaim the trust principal and income.

(G) Pour over or open trust. Pour over or open trust means a trust which may be expanded from time to time by the addition to the trust principal (e.g., a trust established to receive the monthly payment of an annuity, a workers' compensation settlement, a disability benefit or other periodic receivable). The principal may accumulate or grow depending upon whether the trustee distributes the receivable or permits it to accumulate. Generally, the terms of the trust will determine the availability of the income in the month of receipt and the availability of the principal in subsequent months.

(H) Primary beneficiary. Primary beneficiary means the first person or class of persons to receive the benefits of the trust.

(I) Revocable trust. Revocable trust means a trust in which the grantor has retained the right to terminate or revoke the trust and reclaim the trust principal and income. Unless a trust is specifically made irrevocable, it is revocable. Even an irrevocable trust is revocable upon the written consent of all living persons with an interest in the trust.

(J) Secondary beneficiary. Secondary beneficiary means the person or class of persons who will receive the benefits of the trust after the primary beneficiary has died or is otherwise no longer entitled to benefits.

(K) Testamentary trust. Testamentary trust means a trust created by a will and effective upon the death of the individual making the will.

(L) Trustee. Trustee means an individual, individuals, a corporation, court, bank or combination thereof with responsibility for carrying out the terms of the trust.

(3) Documents needed. To determine the availability of a trust for an individual applying for or receiving SoonerCare, copies of the following documents are obtained:

(A) Trust document;

(B) When applicable, all relevant court documents including the Order establishing the trust, Settlement Agreement, Journal Entry, etc.; and

(4) Trust accounts established on or before August 10, 1993. The rules found in (A) - (C) of this paragraph apply to trust accounts established on or before August 10, 1993.

(A) Support trust. The purpose of a support trust is the provision of support or care of a beneficiary. A support trust will generally contain language such as "to provide for the care, support and maintenance of ...", "to provide as necessary for the support of ...", or "as my trustee may deem necessary for the support, maintenance, medical expenses, care, comfort and general welfare." Except as provided in (i)-(iii) of this subparagraph, the amount from a support trust deemed available to the beneficiary is the maximum amount of payments that may be permitted under the terms of the trust to be distributed to the beneficiary, assuming the full exercise of discretion by the trustee(s) for distribution of the maximum amount to the beneficiary. The beneficiary of a support trust, under which the distribution of payments to the beneficiary is determined by one or more trustees who are permitted to exercise discretion with respect to distributions, may show that the amounts deemed available are not actually available by:

(i) Commencing proceedings against the trustee(s) in a court of competent jurisdiction;

(ii) Diligently and in good faith asserting in the proceedings that the trustee(s) is required to provide support out of the trust; and

(iii) Showing that the court has made a determination, not reasonably subject to appeal, that the trustee must pay some amount less than the amount deemed available. If the beneficiary makes the showing, the amount deemed available from the trust is the amount determined by the court. Any action by a beneficiary or the beneficiary's representative, or by the trustee or the trustee's representative, in attempting a showing to make the Agency or the State of Oklahoma a party to the proceeding, or to show to the court that SoonerCare benefits may be available if the court limits the amounts deemed available under the trust, precludes the showing of good faith required.

(B) Medicaid Qualifying Trust (MQT). A MQT is a trust, or similar legal device, established (other than by will) by an individual or an individual's spouse, under which the individual may be the beneficiary of all or part of the distributions from the trust and such distributions are determined by one or more trustees who are permitted to exercise any discretion with respect to distributions to the individual. A trust established by an individual or an individual's spouse includes trusts created or approved by a representative of the individual (parent, guardian or person holding power of attorney) or the court where the property placed in trust is intended to satisfy or settle a claim made by or on behalf of the individual or the individual's spouse. This includes trust accounts or similar devices established for a minor child pursuant to 12 Oklahoma Statutes 83. In addition, a trust established jointly by at least one of the individuals who can establish an MQT and another party or parties (who do not qualify as one of these individuals) is an MQT as long as it meets the other MQT criteria. The amount from an irrevocable MQT deemed available to the individual is the maximum amount of payments that may be permitted under the terms of the trust to be distributed to the individual assuming the full exercise of discretion by the trustee(s). The provisions regarding MQT apply even though an MQT is irrevocable or is established for purposes other than enabling an individual to qualify for SoonerCare, and, whether or not discretion is actually exercised.

(i) Similar legal device. MQT rules listed in this subsection also apply to "similar legal devices" or arrangements having all the characteristics of an MQT except that there is no actual trust document. An example is the member petitioning the court to irrevocably assign all or part of his/her income to another party (usually the spouse). The determination whether a given document or arrangement constitutes a "similar legal device" should be made by the OKDHS Office of General Counsel, Legal Unit.

(ii) MQT resource treatment. For revocable MQTs, the entire principal is an available resource to the member. Resources comprising the principal are subject to the individual resource exclusions (e.g., the home property exclusion) since the member can access those resource items without the intervention of the trustee. For irrevocable MQTs, the countable amount of the principal is the maximum amount the trustee can disburse to (or for the benefit of) the member, using his/her full discretionary powers under the terms of the trust. If the trustee has unrestricted access to the principal and has discretionary power to disburse the entire principal to the member (or to use it for the member's benefit), the entire principal is an available resource to the member. Resources transferred to such a trust lose individual resource consideration (e.g., home property transferred to such a trust is no longer home property and the home property exclusions do not apply). The value of the property is included in the value of the principal. If the MQT permits a specified amount of trust income to be distributed periodically to the member (or to be used for his/her benefit), but those distributions are not made, the member's countable resources increase cumulatively by the undistributed amount.

(iii) Income treatment. Amounts of MQT income distributed to the member are countable income when distributed. Amounts of income distributed to third parties for the member's benefit are countable income when distributed.

(iv) Transfer of resources. If the MQT is irrevocable, a transfer of resources has occurred to the extent that the trustee's access to the principal (for purposes of distributing it to the member or using it for the member's benefit) is restricted (e.g., if the trust stipulates that the trustee cannot access the principal but must distribute the income produced by that principal to the member, the principal is not an available resource and has, therefore, been transferred).

(C) Special needs trusts. Some trusts may provide that trust benefits are intended only for a beneficiary's "special needs" and require the trustee to take into consideration the availability of public benefits and resources, including SoonerCare benefits. Some trusts may provide that the trust is not to be used to supplant or replace public benefits, including SoonerCare benefits. If a trust contains such terms and is not an MQT, the trust is not an available resource.

(5) Trust accounts established after August 10, 1993. The rules found in (A) - (C) of this paragraph apply to trust accounts established after August 10, 1993.

(A) For purposes of this subparagraph, the term "trust" includes any legal document or device that is similar to a trust. An individual is considered to have established a trust if assets of the individual were used to form all or part of the principal of the trust and if the trust was established other than by will and by any of the following individuals:

(i) the individual;

(ii) the individual's spouse;

(iii) a person, including a court or administrative body, with legal authority to act in place of or on behalf of the individual or the individual's spouse; or

(iv) a person, including a court or administrative body, acting at the direction or upon the request of the individual or the individual's spouse.

(B) Where trust principal includes assets of an individual described in this subparagraph and assets of any other person(s), the provisions of this subparagraph apply to the portion of the trust attributable to the assets of the individual. This subparagraph applies without regard to the purposes for which the trust is established, whether the trustees have or exercise any discretion under the trust, and restrictions on when or whether distributions may be made from the trust, or any restrictions on the use of the distribution from the trust.

(i) In the case of a revocable trust, the principal is considered an available resource to the individual. Payments from the trust to or for the benefit of the individual are considered income of the individual.¢ 1Other payments from the trust are considered assets disposed of by the individual for purposes of the transfer of assets rule and are subject to the 60 months look back period.

(ii) In the case of an irrevocable trust, if there are any circumstances under which payments from the trust could be made to or for the benefit of the individual, the portion of the principal of the trust, or the income on the principal, from which payment to the individual could be made is considered available resources. Payments from the principal or income of the trust is considered income of the individual. Payments for any other purpose are considered a transfer of assets by the individual and are subject to the 60 months look back period. Any portion of the trust from which, or any income on the principal from which no payment could under any circumstances be made to the individual is considered as of the date of establishment of the trust (or if later, the date on which payment to the individual was foreclosed) to be assets disposed by the individual for purposes of the asset transfer rules and are subject to the 60 months look back period.¢ 2

(6) Exempt trusts. Paragraph (5) of this subsection does not apply to the following trusts:

(A) A trust containing the assets of a disabled individual under the age of 65 which was established for the benefit of such individual by the individual, parent, grandparent, legal guardian of the individual or a court if the State receives all amounts remaining in the trust on the death of the individual up to an amount equal to the total medical assistance paid on behalf of the individual. This type of trust requires:

(i) The trust may only contain the assets of the disabled individual.

(ii) The trust must be irrevocable and cannot be amended or dissolved without the written agreement of the OKDHS or the Oklahoma Health Care Authority(OHCA).

(iii) Trust records must be open at all reasonable times to inspection by an authorized representative of the OHCA or OKDHS.

(iv) The exception for the trust continues after the disabled individual reaches age 65. However, any addition or augmentation after age 65 involves assets that were not the assets of an individual under age 65; therefore, those assets are not subject to the exemption.

(v) Establishment of this type of trust does not constitute a transfer of assets for less than fair market value if the transfer is made into a trust established solely for the benefit of a disabled individual under the age of 65.

(vi) Payments from the trust are counted according to SSI rules. According to these rules, countable income is anything the individual receives in cash or in kind that can be used to meet the individual's needs for food, clothing and shelter. Accordingly, any payments made directly to the individual are counted as income to the individual because the payments could be used for food, clothing, or shelter for the individual. This rule applies whether or not the payments are actually used for these purposes, as long as there is no legal impediment which would prevent the individual from using the payments in this way. In addition, any payments made by the trustee to a third party to purchase food, clothing, or shelter for the individual can also count as income to the individual. For example, if the trustee makes a mortgage payment for the individual, that payment is a shelter expense and counts as income.

(vii) A corporate trustee may charge a reasonable fee for services in accordance with its published fee schedule.

(viii) The OKDHS Form 08MA018E, Supplemental Needs Trust, is an example of the trust. Workers may give the sample form to the member or his/her representative to use or for their attorney's use.

(ix) To terminate or dissolve a Supplemental Needs Trust, the worker sends a copy of the trust instrument and a memorandum to OKDHS Family Support Services Division, Attention: Health Related and Medical Services (HR&MS) explaining the reason for the requested termination or dissolution of the Supplemental Needs Trust, and giving the name and address of the trustee. The name and address of the financial institution and current balance are also required. Health Related and Medical Services notifies Oklahoma Health Care Authority/Third Party Liability(OHCA/TPL) to initiate the recovery process.

(B) A trust (known as the Medicaid Income Pension Trust) established for the benefit of an individual if:

(i) The individual is in need of long-term care and has countable income above the categorically needy standard for long-term care (OKDHS Appendix C-1 Schedule VIII.B) but less than the average cost of nursing home care per month (OKDHS Appendix C-1 Schedule VIII.B).

(ii) The Trust is composed only of pension, social security, or other income of the individual along with accumulated income in the trust. Resources cannot be included in the trust.

(iii) All income is paid into the trust and the applicant is not eligible until the trust is established and the monthly income has been paid into the trust.

(iv) The trust must retain an amount equal to the member's gross monthly income less the current categorically needy standard of OKDHS Appendix C-1. The Trustee distributes the remainder.

(v) The income disbursed from the trust is considered as the monthly income to determine the cost of their care, and can be used in the computations for spousal diversion.

(vi) The trust must be irrevocable and cannot be amended or dissolved without the written agreement of the OHCA. Trust records must be open at all reasonable times to inspection by an authorized representative of the OHCA or OKDHS.

(vii) The State will receive all amounts remaining in the trust up to an amount equal to the total SoonerCare benefits paid on behalf of the individual subsequent to the date of establishment of the trust.

(viii) Accumulated funds in the trust may only be used for medically necessary items not covered by SoonerCare, or other health programs or health insurance and a reasonable cost of administrating the trust. Reimbursements cannot be made for any medical items to be furnished by the nursing facility. Use of the accumulated funds in the trust for any other reason will be considered as a transfer of assets and would be subject to a penalty period.¢ 3

(ix) The trustee may claim a fee of up to 3% of the funds added to the trust that month as compensation.

(x) An example trust is included on OKDHS Form 08MA011E. Workers may give this to the member or his/her representative to use or for their attorney's use as a guide for the Medicaid Income Pension Trust.

(xi) To terminate or dissolve a Medicaid Income Pension Trust, the worker sends a memorandum with a copy of the trust to OKDHS Family Support Services Division, Attention: HR&MS, explaining the reason and effective date for the requested termination or dissolution of the Medicaid Income Pension Trust, and giving the name and address of the trustee. The name and address of the financial institution, account number, and current balance are also required. Health Related and Medical Services notifies OHCA/TPL to initiate the recovery process.

(i) The trust is established and managed by a non-profit association;

(ii) The trust must be made irrevocable;

(iii) The trust must be approved by the OKDHS and may not be amended without the permission of the OKDHS;

(iv) The disabled person has no ability to control the spending in the trust;

(v) A separate account is maintained for each beneficiary of the trust but for the purposes of investment and management of funds, the trust pools these accounts;

(vi) The separate account on behalf of the disabled person may not be liquidated without payment to OHCA for the medical expenses incurred by the members;

(vii) Accounts in the trust are established by the parent, grandparent, legal guardian of the individual, the individual, or by a court;

(viii) To the extent that amounts remaining in the beneficiary's account on the death of the beneficiary are not retained by the trust, the trust pays to the State from such remaining amounts an amount equal to the total medical assistance paid on behalf of the individual. A maximum of 30% of the amount remaining in the beneficiary's account at the time of the beneficiary's death may be retained by the trust.

(7) Funds held in trust by Bureau of Indian Affairs (BIA). Interests of individual Indians in trust or restricted lands are not considered in determining eligibility for assistance under the Social Security Act or any other federal or federally assisted program.

(8) Disbursement of trust. At any point that disbursement occurs, the amount disbursed is counted as a non-recurring lump sum payment in the month received. Some trusts generate income on a regular basis and the income is sent to the beneficiary. In those instances, the income is treated as unearned income in the month received.

INSTRUCTIONS TO STAFF 317:35-5-41.6

Revised ~~3-15-17~~12-1-18

1.Effective September 1, 2016, home property in a revocable trust was considered an available resource.When an individual's home property is in a revocable trust, the worker informs the individual or his or her representative that the home property exemption does not apply unless the property is removed from the revocable trust.The worker provides the individual or his or her representative with Form 08AD092E, Client Contact and Information Request, giving the individual 10-calendar days to provide proof the property was removed from the trust.

(1) When the individual does not remove the property from the trust and the value exceeds the resource limit per Schedule VIII.D of the Oklahoma Department of Human Services Appendix C-1, Maximum Income, Resource, and Payment Standards, the worker denies or closes the SoonerCare (Medicaid) benefit.

(2) When the individual:

(A) lives in the home and provides proof the home was removed from the revocable trust, it is excluded as home property;

(B) does not live in the home or a nursing facility and does not plan to return home, he or she must take steps to convert the property for use in meeting his or her current needs per Oklahoma Administrative Code 317:35-5-41.1(b)(1); or

(C) lives in a nursing facility, refer to Oklahoma Administrative Code 317:35-5-41.8 for the home property exemption time frame.

2.Per Section 4001.1 of Title 56 of the Oklahoma Statutes (56 O.S. § 4001.1) money and assets in an individual's savings or trust account owned by the designated beneficiary of the account and established to pay qualified disability expenses is excluded per the Oklahoma Achieving a Better Life Experience (ABLE) Program or an ABLE program in any other state for the purpose of determining eligibility to receive, or the amount of, any assistance or benefits from local or state means-tested programs.An individual may only have one ABLE account.The individual must provide documents to verify that the account meets exemption criteria before the funds are exempted from resource and income consideration.

(1) The Oklahoma State Treasurer is responsible for certifying an ABLE account. The program name is Oklahoma STABLE.The program is administered through a partnership with Ohio's STABLE Accounts which are backed by Intuition ABLE Solutions, LLC.Rules regarding an ABLE account include:

(A) only individuals whose disability was established before 26 years of age can set up ABLE Act accounts and one account is allowed per individual;

(B) there is no limit to the number of persons who can contribute to the ABLE account; and

(C) upon the death of an ABLE Act participant, every dollar remaining in the account must be paid to the state Medicaid agency to repay costs of care received by the individual during life, up to the amount Medicaid paid.

(2) At application and renewal, the individual must provide proof from the financial institution of the dates and amounts of money deposited into and withdrawn from the ABLE account in the last 12 months.

(B) When money is withdrawn to pay qualified disability expenses, the amount withdrawn is excluded from income or resource consideration.

(i) The individual must verify, preferably from the financial institution, that the withdrawn funds were used for qualified disability expenses.

(ii) Funds withdrawn and not used for qualified disability expenses are considered as income for the month of withdrawal.

(A) education;

(B) housing;

(C) transportation;

(D) employment, training, and support;

(E) assistive technology. and personal support services;

(F) health, prevention and wellness, financial management, and administrative expenses;

(G) legal fees;

(H) oversight and monitoring; and

(I) funeral and burial expenses.

3.(a) Expenditures from a Medicaid Income Pension Trust (MIPT) must be submitted to Adult and Family Services (AFS) Health Related and Medical Services (HR&MS) staff for approval.Without AFS HR&MS approval, it is an unapproved expenditure and an overpayment written for the month when the funds were spent.To prevent an overpayment, the trustee is responsible for ensuring the MIPT is fully funded.To obtain approval, the worker:

(1) mails or emails the HR&MS mailbox with information regarding the cost and medical need of the expenditure;

(2) images supporting documents in the case record, such as a health professional's statement as to the medical necessity of the expenditure and a cost statement; and

(3) documents the request in Family Assistance/Client Services case notes.

(b) Examples of medically-necessary expenditures HR&MS may approve, include dental work and hearings aids.

(c) HR&MS does not approve:

(1) medically-necessary items that Medicare or the nursing facility is required to provide, such as diapers, lift chairs, wheelchairs, or walkers; or

(2) expenditures that are not medically necessary, such as the extra cost associated with a private room, transportation, or vacations.

PART 7.APPLICATION AND ELIGIBILITY DETERMINATION PROCEDURES

317:35-5-42. Determination of countable income for individuals categorically related to aged, blind and disabled

Revised 9-14-18

(a) General. The term income is defined as that gross gain or gross recurrent benefit which is derived from labor, business, property, retirement and other benefits, and many other forms which can be counted on as currently available for use on a regular basis. When an individual's income is reduced due to recoupment of an overpayment or garnishment, the gross amount before the recoupment or garnishment is counted as income.¢ 1Verification of the member's countable income or resources held in bank accounts or at other financial institutions can be established through an Asset Verification System (AVS).¢ 2

(1) If it appears the applicant or SoonerCare member is eligible for any type of income (excluding SSI) or resources, he/she must be notified in writing by the Agency of his/her potential eligibility.¢ 3The notice must contain the information that failure to file for and take all appropriate steps to obtain such benefit within 30 days from the date of the notice will result in a determination of ineligibility.

(2) If a husband and wife are living in their own home, the couple's total income and/or resource is divided equally between the two cases. If they both enter a nursing facility, their income and resources are considered separately.

(3) If only one spouse in a couple is eligible and the couple ceases to live together, only the income and resources of the ineligible spouse that are actually contributed to the eligible spouse beginning with the month after the month which they ceased to live together are considered.

(4) In calculating monthly income, cents are included in the computation until the monthly amount of each individual's source of income has been established. When the monthly amount of each income source has been established, cents are rounded to the nearest dollar (1 - 49 cents is rounded down, and 50 - 99 cents is rounded up). For example, an individual's weekly earnings of $99.90 are multiplied by 4.3 and the cents rounded to the nearest dollar ($99.90 x 4.3 = $429.57 rounds to $430). See rounding procedures in OAC 340:65-3-4 when using BENDEX to verify OASDI benefits.

(b) Income disregards. In determining need, the following are not

considered as income:¢ 4

(1) The value of Supplemental Nutrition Assistance Program (food stamps) received;

(2) Any payment received under Title II of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970;

(3) Educational grants (excluding work study), scholarships, etc., that are contingent upon the student regularly attending school. The student's classification (graduate or undergraduate) is not a factor;

(4) Loans (regardless of use) if a bona fide debt or obligation to pay can be established. Criteria to establish a loan as bona fide includes:

(A) An acknowledgment of obligation to repay or evidence that the loan was from an individual or financial institution in the loan business. If the loan agreement is not written, an OKDHS Form 08AD103E, Loan Verification, should be completed by the borrower attesting that the loan is bona fide and signed by the lender verifying the date and amount of loan. When copies of written agreements or OKDHS Form 08AD103E are not available, detailed case documentation must include information that the loan is bona fide and how the debt amount and date of receipt was verified.

(B) If the loan was from a person(s) not in the loan business, the borrower's acknowledgment of obligation to repay (with or without interest) and the lender's verification of the loan are required to indicate that the loan is bona fide.

(5) One-third of child support payments received on behalf of the disabled minor child;

(6) Indian payments (including judgment funds or funds held in trust) distributed by the Secretary of the Interior (BIA) or distributed by the tribe subject to approval by the Secretary of the Interior. Also, any interest or investment income accrued on such funds while held in trust or any purchases made with judgment funds, trust funds, interest or investment income accrued on such funds. Any income from mineral leases, from tribal business investments, etc. However, any interest or income derived from the principal or produced by purchases made with funds after distribution is considered as any other income;

(7) Special allowance for school expenses made available upon petition (in writing) for funds held in trust for the student;

(8) Title III benefits from State and Community Programs on Aging;

(9) Payment for supportive services or reimbursement of out-of-pocket expenses made to individual volunteers serving as foster grandparents, senior health aides, or senior companions, and to persons serving in the Service Corps of Retired Executives (SCORE) and Active Corps of Executives (ACE);

(10) Payments to volunteers under the Domestic Volunteer Services Act of 1973 (VISTA), unless the gross amount of VISTA payments equals or exceeds the state or federal minimum wage, whichever is greater;

(11) The value of supplemental food assistance received under the Child Nutrition Act or the special food service program for children under the National School Lunch Act;

(12) Any portion of payments made under the Alaska Native Claims Settlement Act to an Alaska Native which are exempt from taxation under the Settlement Act;

(13) Reimbursements from an employer for out-of-pocket expenditures and allowances for travel or training to the extent the funds are used for expenses directly related to such travel or training and uniform allowance if the uniform is uniquely identified with company names or logo;

(14) Assistance or services from the Vocational Rehabilitation program such as transportation expenses to a rehabilitation center, extra clothing, lunches, grooming needed for a training program and any other such complementary payments;

(15) Experimental Housing Allowance Program (EHAP) payments made under Annual Contributions Contracts entered into prior to January 1, 1975, under Section 23 of the U.S. Housing Act of 1937, as amended;

(16) Payments made by a public or private non-profit child care agency for a child placed in foster care or subsidized adoption;

(17) Governmental rental or housing subsidies by governmental agencies, e.g., HUD (received in-kind or in cash) for rent, mortgage payments, or utilities;

(18) LIHEAP payments for energy assistance and payments for emergency situations under Emergency Assistance to Needy Families with Children;

(19) Payments made from the Agent Orange Settlement Fund or any other fund established pursuant to the settlement in the In Re Agent Orange product liability litigation, M.D.L. No. 381 (E.D.N.Y.);

(20 Payments made from the Radiation Exposure Compensation Trust Fund as compensation for injuries or deaths resulting from the exposure to radiation from nuclear testing and uranium mining;

(21) Federal major disaster and emergency assistance provided under the Disaster Relief Act of 1974, and comparable disaster assistance provided by States, local governments, and disaster assistance organizations;

(22) Income of a sponsor to the sponsored eligible alien;

(23) Income that is set aside under an approved Plan for Achieving Self-Support for Blind or Disabled People (PASS). The Social Security Administration approves the plan, the amount of income excluded and the period of time approved. A plan can be approved for an initial period of 18 months. The plan may be extended for an additional 18 months if needed, and an additional 12 months (total 48 months) when the objective involves a lengthy educational or training program;

(24) Payments made to individuals because of their status as victims of Nazi persecution (PL 103-286);

(25) Payments received under the Civil Liberties Act of 1988. These payments are to be made to individuals of Japanese ancestry who were detained in internment camps during World War II;

(26) Payments received as a result of participation in a class action lawsuit entitled "Factor VIII or IX Concentrate Blood Products Litigation". These payments are made to hemophilia patients who are infected with HIV. However, if the payments are placed in an interest-bearing account, or some other investment medium that produces income, the income generated by the account may be countable as income to the individual;

(27) Payments made to certain Vietnam veterans' children with spina bifida (PL 104-204);

(28) Payments made to certain Korea service veterans' children with spina bifida (PL 108-183);

(29) Payments made to the children of women Vietnam veterans who suffer from certain birth defects (PL 106-419);

(30) Additional payments of regular unemployment compensation in the amount of $25 per week ending June 30, 2010, and any amount of emergency unemployment compensation paid through May 31, 2010, as authorized under the American Recovery and Reinvestment Tax Act of 2009;

(31) Wages paid by the Census Bureau for temporary employment related to Census activities;

(32) Income tax refunds;

(33) Home energy assistance;

(34) Food or shelter based on need provided by nonprofit agencies;

(35) Money someone else spends to pay your expenses for items other than food or shelter (e.g., someone pays for your telephone or medical bills);

(36) Earned income for working students younger than 22 years of age when they regularly attend a school, college, university or a course of vocational or technical training. Refer to Appendix C-1, Schedule VIII.E; Maximum Income, Resource and Payment Standards for the maximum monthly and yearly exclusion amounts;

(37) The cost of impairment-related work expenses for items or services that a disabled person needs in order to work; and

(38) The first $2,000 of compensation received per calendar year for participating in certain clinical trials.

(c) Determination of income. The member is responsible for reporting information regarding all sources of available income. This information is verified and used by the worker in determining eligibility.

(1) Gross income is listed for purposes of determining eligibility. It may be derived from many sources, and some items may be automatically disregarded by the computer when so provided by state or federal law.

(2) If a member is determined to be categorically needy and is also an SSI recipient, any change in countable income (see OAC 317:35-5-42(d)(3) to determine countable income) will not affect receipt of SoonerCare and amount of State Supplemental Payment (SSP) as long as the amount does not cause SSI ineligibility.¢ 5Income which will be considered by SSI in the retrospective cycle is documented in the case with computer update at the time that SSI makes the change (in order not to penalize the member twice). If the SSI change is not timely, the worker updates the computer using the appropriate date as if it had been timely. If the receipt of the income causes SSI ineligibility, the income is considered immediately with proper action taken to reduce or close the SoonerCare benefit and SSP case. Any SSI overpayment caused by SSA not making timely changes will result in recovery by SSI in the future. When the worker becomes aware of income changes which will affect SSI eligibility or payment amount, the information is to be shared with the SSA office.

(3) Some of the more common income sources to be considered in determining eligibility are as follows:

(A) Retirement and disability benefits. These include but are not limited to OASDI, VA, Railroad Retirement, SSI, and unemployment benefits. Federal and State benefits are considered for the month they are intended when determining eligibility.

(i) Verifying and documenting the receipt of the benefit and the current benefit amount are achieved by:

(I) seeing the member's award letter or warrant;

(II) obtaining a signed statement from the individual who cashed the warrant; or

(III) by using BENDEX and SDX.

(ii) Determination of OASDI benefits to be considered (disregarding COLA's) for former State Supplemental recipients who are reapplying for medical benefits under the Pickle Amendment must be computed according to OKDHS Form 08AX011E.

(iii) The Veterans Administration allows their recipients the opportunity to request a reimbursement for medical expenses not covered by SoonerCare. If a recipient is eligible for the readjustment payment, it is paid in a lump sum for the entire past year. This reimbursement is disregarded as income and a resource in the month it is received; however, any amount retained in the month following receipt is considered a resource.

(iv) Government financial assistance in the form of VA Aid and Attendance or Champus payments is considered as follows:

(I) Nursing facility care. VA Aid and Attendance or Champus payment whether paid directly to the member or to the facility, are considered as third party resources and do not affect the income eligibility or the vendor payment of the member.

(II) Own home care. The actual amount of VA Aid and Attendance payment paid for an attendant in the home is disregarded as income. In all instances, the amount of VA Aid and Attendance is shown on the computer form.

(v) Veterans or their surviving spouse who receive a VA pension may have their pension reduced to $90 by the VA if the veteran does not have dependents, is SoonerCare eligible, and is residing in a nursing facility that is approved under SoonerCare. Section 8003 of Public Law 101-508 allows these veterans' pensions to be reduced to $90 per month. None of the $90 may be used in computing any vendor payment or spenddown. In these instances, the nursing home resident is entitled to the $90 reduced VA pension as well as the regular nursing facility maintenance standard. Any vendor payment or spenddown will be computed by using other income minus the monthly nursing facility maintenance standard minus any applicable medical deduction(s). Veterans or their surviving spouse who meet these conditions will have their VA benefits reduced the month following the month of admission to a SoonerCare approved nursing facility.¢ 6

(B) SSI benefits. SSI benefits may be continued up to three months for a recipient who enters a public medical or psychiatric institution, a SoonerCare approved hospital, extended care facility, intermediate care facility for the mentally retarded or nursing facility. To be eligible for the continuation of benefits, the SSI recipient must have a physician's certification that the institutionalization is not expected to exceed three months and there must be a need to maintain and provide expenses for the home. These continued payments are intended for the use of the recipient and do not affect the vendor payment.¢ 7

(i) Any income received in a lump sum (with the exception of SSI lump sum) covering a period of more than one month, whether received on a recurring or nonrecurring basis, is considered as income in the month it is received. Any amount from any lump sum source, including SSI (with the exception of dedicated bank accounts for disabled/blind children under age 18), retained on the first day of the next month is considered as a resource. Such lump sum payments may include, but are not limited to, accumulation of wages, retroactive OASDI, VA benefits, Workers' Compensation, bonus lease payments and annual rentals from land and/or minerals.

(ii) Lump sum payments used to establish dedicated bank accounts by representative payees in order to receive and maintain retroactive SSI benefits for disabled/blind children under age 18 are excluded as income. The interest income generated from dedicated bank accounts is also excluded. The dedicated bank account consisting of the retroactive SSI lump sum payment and accumulated interest is excluded as a resource in both the month received and any subsequent months.

(iii) A life insurance death benefit received by an individual while living is considered as income in the month received and as a resource in the following months to the extent it is available.

(iv) Changing a resource from one form to another, such as converting personal property to cash, is not considered a lump sum payment.

(D) Income from capital resources and rental property. Income from capital resources can be derived from rental of a house, rental from land (cash or crop rent), leasing of minerals, life estate, homestead rights or interest.

(i) If royalty income is received monthly but in irregular amounts, an average based on the previous six months' royalty income is computed and used to determine income eligibility. When the difference between the gross and net income represents a production or severance tax (e.g., most oil royalties are reduced by this tax), the OHCA only uses the net figure when determining income eligibility. The production or severance tax is the cost of producing the income, and, therefore, is deducted from the gross income. Exception: At any time that the county becomes aware of and can establish a trend showing a dramatic increase or decrease in royalty income, the previous two months' royalty income is averaged to compute countable monthly income.

(ii) Rental income may be treated as earned income when the individual participates in the management of a trade or business or invests his/her own labor in producing the income. The individual's federal income tax return will verify whether or not the income is from self-employment. Otherwise, income received from rental property is treated as unearned income.

(iii) When rental property is handled by a leasing agent who collects the rent and deducts a management fee, only the rent actually received by the member is considered as income.

(E) Earned income/self-employment. The term "earned income" includes income in cash earned by an individual through the receipt of wages, salary, commission, or profit from activities in which he/she is engaged as a self-employed individual or as an employee. See subparagraph (G) of this paragraph for earnings received in fluctuating amounts. "Earned Income" is also defined to include in-kind benefits received by an employee from an employer in lieu of wages or in conjunction with wages. Such benefits received in-kind are considered as earned income only when the employee/employer relationship has been established. The cash value of the in-kind benefits must be verified by the employer. Income from self-employment also includes in-kind benefits for a work activity or service for which the self-employed person ordinarily receives payment in his/her business enterprise. An exchange of labor or services, e.g., barter, is considered as an in-kind benefit. Medical insurance secured through the employer, whether purchased or as a benefit, is not considered in-kind but is recorded on the case computer input document for coordination with SoonerCare benefits.

(i) Work study received by an individual who is attending school is considered as earned income with appropriate earned income disregards applied.

(ii) Money from the sale of whole blood or blood plasma is considered as self-employment income subject to necessary business expenses and appropriate earned income disregards.¢ 8

(iii) Self-employment income is determined as follows:

(I) Generally, the federal or state income tax form for the most recent year is used for calculating the self-employment income to project income on a monthly basis for the certification period. The gross income amount, as well as the allowable deductions, are the same as can be claimed under the Internal Revenue code for tax purposes.

(II) Self-employment income which represents a household's annual support is prorated over a 12- month period, even if the income is received in a short period of time. For example, self-employment income received by crop farmers is averaged over a 12-month period if the income represents the farmer's annual support.

(III) If the household's self-employment enterprise has been in existence for less than a year, the income from that self-employment enterprise is averaged over the period of time the business has been in operation to establish the monthly income amount.

(IV) If a tax return is not available because one has not been filed due to recent establishment of the self-employment enterprise, a profit and loss statement must be seen to establish the monthly income amount.

(V) The purchase price and/or payment(s) on the principal of loans for capital assets, equipment, machinery, and other durable goods is not considered as a cost of producing self-employed income. Also not considered are net losses from previous periods, depreciation of capital assets, equipment, machinery, and other durable goods; and federal, state and local income taxes, FICA, money set aside for retirement purposes, and other work related personal expenses, such as meals and necessary transportation (these expenses are accounted for by the work related expense deduction given in OAC 340:10-3-33(1)).

(iv) Countable self-employment income is determined by deducting allowable business expenses to determine the adjusted gross income. The earned income deductions are then applied to establish countable earned income.

(F) Infrequent or irregular income.

(i) Income is considered to be infrequent if the individual receives it only once during a calendar quarter from a single source and the individual did not receive that type of income in the month preceding or following the month the income was received.

(ii) Income is considered to be irregular if the individual cannot reasonably expect to receive it.

(iii) OHCA excludes the following amount of infrequent or irregular income:

(I) the first $30 per calendar quarter of earned income; and

(II) the first $60 per calendar quarter of unearned income.

(iv) Infrequent or irregular income, whether earned or unearned, that exceeds these amounts is considered countable income in the month it is received. ¢ 9

(G) Monthly income received in fluctuating amounts. Income which is received monthly but in irregular amounts is averaged using two months' income, if possible, to determine income eligibility. Less than two months' income may be used when circumstances (e.g., new employment, unpaid sick leave, etc.) would indicate that previous income amounts would not be appropriate to use in determining future income amounts. Income received more often than monthly is converted to monthly amounts as follows:

(i) Daily. Income received on a daily basis is converted to a weekly amount then multiplied by 4.3.

(ii) Weekly. Income received weekly is multiplied by 4.3.

(iii) Twice a month. Income received twice a month is multiplied by 2.

(iv) Biweekly. Income received every two weeks is multiplied by 2.15.

(H) Non-negotiable notes and mortgages. Installment payments received on a note, mortgage, etc., are considered as monthly income.

(I) Income from the Job Training and Partnership Act (JTPA). Unearned income received by an adult, such as a needs based payment, cash assistance, compensation in lieu of wages, allowances, etc., from a program funded by JTPA is considered as any other unearned income. JTPA earned income received as wages is considered as any other earned income.

(J) Other income. Any other monies or payments which are available for current living expenses must be considered.

(d) Computation of income.

(1) Earned income or unearned income. The general income exclusion of $20 per month is allowed for earned or unearned income, unless the unearned income is SSP, on the combined income of the eligible individual and eligible or ineligible spouse. ¢ 9See paragraph (5) of this subsection if there are ineligible minor children. After the $20 exclusion, deduct $65 and one-half of the remaining combined earned income. The total gross amount of unearned income of the eligible individual and eligible or ineligible spouse is considered.

(2) Countable income. The countable income is the sum of the earned income and the total gross unearned income after exclusions.¢ 10

(3) Deeming computation for disabled or blind minor child(ren). An automated calculation is available for computing the income amount to be deemed from parent(s) and the spouse of the parent to eligible disabled or blind minor child(ren) by use of transaction CID. The ineligible minor child in the computation regarding allocation for ineligible child(ren) is defined as: a dependent child under age 18.

(A) An intellectually disabled child living in the home who is ineligible for SSP due to the deeming process may be approved for SoonerCare under the Home and Community Based Services Waiver (HCBS) Program as outlined in OAC 317:35-9-5.¢ 11

(B) For TEFRA, the income of child's parent(s) is not deemed to him/her.¢ 12

(4) Premature infants. Premature infants (i.e., 37 weeks or less) whose birth weight is less than 1200 grams (approximately 2 pounds 10 ounces) will be considered disabled by SSA even if no other medical impairment(s) exist. In this event, the parents' income is not deemed to the child until the month following the month in which the child leaves the hospital and begins living with his/her parents.

(5) Procedures for deducting ineligible minor child allocation. When an eligible individual has an ineligible spouse and ineligible minor children (not receiving TANF), the computation is as follows:

(A) Each ineligible child's allocation (OKDHS Form 08AX001E, Schedule VII. C.) minus each child's gross countable income is deducted from the ineligible spouse's income. Deeming of income is not done from child to parent.¢ 5

(B) The deduction in subparagraph (A) of this paragraph is prior to deduction of the general income exclusion and work expense.

(C) After computations in subparagraphs (A) and (B) of this paragraph, the remaining amount is the ineligible spouse's countable income considered available to the eligible spouse.

(6) Special exclusions for blind individuals. Any blind individual who is employed may deduct the general income exclusion and the work exclusion from the gross amount of earned income. After the application of these exclusions, one-half of the remaining income is excluded. The actual work expense is then deducted from the remaining half to arrive at the amount of countable income. If this blind individual has a spouse who is also eligible due to blindness and both are working, the amount of ordinary and necessary expenses attributable to the earning of income for each of the blind individuals may be deducted. Expenses are deductible as paid but may not exceed the amount of earned income. To be deductible, an expense need not relate directly to the blindness of the individual, it need only be an ordinary and necessary work expense of the blind individual. Such expenses fall into three broad categories:

(A) transportation to and from work;

(B) job performance; and

INSTRUCTIONS TO STAFF 317:35-5-42

Revised ~~3-15-17~~12-1-18

1.An example of a deduction from gross income that must be counted is child support and back child support.

2.Asset Verification System (AVS) is an electronic system used to verify accounts at financial institutions.

3.When income is below the Supplemental Security Income (SSI) standard, individuals related to aged, blind, or disabled (ABD) must apply for SSI benefits to be eligible for the State Supplemental Payment (SSP) cash assistance.

4.(a) Money deposited into or withdrawn from a qualified Oklahoma Achieving a Better Life Experience (ABLE) Program account per Sections 4001.1 through 4001.5 of Title 56 of the Oklahoma Statutes or a qualified ABLE Program account set up in any other state per the ABLE Act of 2014, (26 U.S.C. § 529A) is excluded as income or a resource when the individual:

(1) provides documents to verify the account meets exemption criteria;

(2) verifies money deposited in the account does not exceed the annual federal gift tax exclusion amount per 26 U.S.C. § 2503(b).The current gift tax exclusion amount is ~~$14,000~~$15,000 per calendar year.Any money deposited in the account in the calendar year that is in excess of the annual federal gift tax exclusion amount is considered as countable income in the amount deposited.The maximum balance in the ABLE account is $300,000; and

(3) verifies withdrawals from the account were used to pay qualified disability expenses.Money withdrawn for reasons other than to pay qualified disability expenses is considered as income for the month of withdrawal.

(b) The Oklahoma State Treasurer is responsible for certifying an ABLE account.The program name is Oklahoma STABLE.The program is administered through a partnership with Ohio's STABLE Accounts which are backed by Intuition ABLE Solutions, LLC.Rules regarding an ABLE account include:

(1) only individuals whose disability was established before 26 years of age can set up ABLE Act accounts and one account is allowed per individual.

(2) there is no limit to the number of persons who can contribute to the ABLE account; and

(3) upon the death of an ABLE Act participant, every dollar remaining in the account must be paid to the state Medicaid agency to repay costs of care received by the individual during life, up to the amount Medicaid paid.

(c) At application and renewal, the individual must provide proof from the financial institution of the dates and amounts of money deposited into and withdrawn from the ABLE account in the last 12 months.

(1)Any money deposited in the account in a calendar year that is in excess of the annual federal gift tax exclusion is considered as countable income in the month deposited and as a resource for the following month.

(2) When money is withdrawn to pay qualified disability expenses, the amount withdrawn is excluded from income or resource consideration.

(A) The individual must verify, preferably from the financial institution, that the withdrawn funds were used for qualified disability expenses.

(B) Funds withdrawn and not used for qualified disability expenses are considered as income for the month of withdrawal.

(3) Qualified disability expenses means any expenses related to the eligible individual's blindness or disability and approved under Section 529A of the Internal Revenue Code that are made for the benefit of an eligible individual who is the designated beneficiary, including, but not limited to, expenses for:

(A) education;

(B) housing;

(C) transportation;

(D) employment, training, and support;

(E) assistive technology and personal support services;

(F) health, prevention and wellness, financial management, and administrative expenses;

(G) legal fees;

(H) oversight and monitoring; and

(I) funeral and burial expenses.

5.After computing the new countable income amount, when the individual continues to be eligible for at least one dollar of SSI, no action is taken on the SoonerCare benefit or SSP amount because SSI makes the correction in retrospective cycle.

6.The Veteran's Affairs (VA) benefit is not reduced to $90 until the individual is residing in the nursing facility, is approved for SoonerCare (Medicaid), and VA is notified.The VA income cannot be disregarded until it is reduced to $90, no matter how long the individual has resided in the nursing facility.

7.It is imperative that SSI be notified as soon as possible when the individual is expected to remain in the nursing facility longer than three months.

8.NOTE:When earned income of $30 or less or unearned income of $60 or less is received from the same source only once per quarter, it is disregarded because it is irregular income.When income is received more than once a quarter from the same source or is received in subsequent months, it must be counted because it is not considered to be irregular income. For example, when an individual receives earned income of $20 in March and $20 in April, it is counted in both months because it was received in subsequent months although in different quarters.When an individual receives irregular income from more than one source, add the incomes together and disregard the first $30 of earned income or the first $60 of unearned income per quarter, when both incomes are received only once.For example, in May an individual receives a birthday gift of $50 and in June he or she receives royalty income of $20.(The individual only receives royalty income when the accumulated royalties reach $15, so he or she rarely gets a check more than once a year.)Since the total is $70 from two sources, the first $60 is disregarded and $10 is counted as unearned income in May.

9.The $20 general income exclusion may be subtracted from the combined earned income or the unearned income, but not both.It is coded in the Income tab of the Family Assistance/Client Services (FACS) Eligibility notebook.The rest of the allowable earned income deductions are coded in the Non-Temporary Assistance for Needy Families (TANF) expense block in the Income tab.

10.When the individual has Medicare, refer to Oklahoma Administrative Code 317:35-7-40, 317:35-7-43, and 317:35-7-46 to determine Medicare buy-in eligibility.

11.The child must first be approved through Developmental Disabilities Services (DDS) for one of the Home and Community Based Services waivers.

12.When the ineligible spouse has earned and unearned income, the ineligible child allocation is deducted first from the unearned income.When there is remaining income, it is deducted from the gross earned income.The $20 general income exclusion is coded in the FACS Eligibility notebook Income tab.The remaining allowable earned income deductions are coded in the Non-TANF expense block in the FACS Income tab.

SUBCHAPTER 7. MEDICAL SERVICES

PART 5. DETERMINATION OF ELIGIBILITY FOR SHORT-TERM MEDICAL SERVICES

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

Revised 9-14-18

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. ¢ 1For persons age 65 and older in mental health hospitals, refer to Oklahoma Administrative Code317:35-9-7.

(1) The individual's/couple's income and resources do not exceed the standards as shown on DHS Appendix C-1, Schedule VI, of which the income standard is based on 100 percent of the Federal Poverty Level.

(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.

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

INSTRUCTIONS TO STAFF 317:35-7-40

Issued 12-1-18

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 can log on to their Online Member Account and print the card; and

(2) Non-Online Enrollment members can contact their local Oklahoma Department of Human Services (DHS) county office to obtain a printed version of the card.DHS 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.

SUBCHAPTER 9. ICF/IID, HCBW/IID, AND INDIVIDUALS 65 OR OLDER IN MENTAL HOSPITALS

PART 9. CERTIFICATION, REDETERMINATION AND NOTIFICATION

317:35-9-75. Certification for long-term medical care through ICF/IID, HCBW/IID services and to persons age 65 and older in a mental health hospital

9-14-18

(a) Application date. If the applicant is found eligible for SoonerCare, certification may be made retroactive for any service provided on or after the first day of the third month prior to the month of application and for future months. The first month of the certification period must be the first month that medical service was provided and the recipient was determined eligible.¢ 1

(b) Certification period for long-term medical care. A certification period of twelve (12) months is assigned for an individual who is approved for long-term care.¢ 2

INSTRUCTIONS TO STAFF 317:35-9-75

Issued 12-1-18

1.The Oklahoma Health Care Authority (OHCA) 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 can log on to their Online Member Account and print the card; and

(2) Non-Online Enrollment members can contact their local Oklahoma Department of Human Services (DHS) county office to obtain a printed version of the card.DHS staff enters the member’s information into the Eligibility tab on the Medicaid Management Information System (MMIS) Extranetand 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 Quest article IICF/IID Authorizations vs. ICF Authorizations for correct level of care coding instructions.

SUBCHAPTER 15. PERSONAL CARE SERVICES

317:35-15-7. Certification for Personal Care

Revised 9-14-18

(a) Personal Care certification period. The first month of the Personal Care certification period must be the first month the member was determined eligible for Personal Care, both financially and medically. When eligibility or ineligibility for Personal Care is established, the local office updates the computer-generated form and the appropriate notice is mailed to the member.¢ 1

(b) Financial certification period. The financial certification period for Personal Care services is 12 months. Redetermination of eligibility is completed according to the categorical relationship.

(c) Medical certification period. A medical certification period of not more than thirty-six (36) months is assigned for an individual who is approved for Personal Care. The certification period for Personal Care is based on the Uniform Comprehensive Tool (UCAT) evaluation and clinical judgment of the Oklahoma Department of Human Services (DHS) area nurse or designee.

INSTRUCTIONS TO STAFF 317:35-15-7

Issued 12-1-18

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

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

SUBCHAPTER 17. ADVANTAGE WAIVER SERVICES

317:35-17-12. Certification for ADvantage program services

Revised 9-14-18

(a) Application date. When the applicant is determined eligible for ADvantage, his/her certification is effective the date that medical and financial eligibility was determined. When eligibility or ineligibility for ADvantage program services is established, the worker updates the authorization and the computer-generated notice is mailed to the member and ADvantage Administration (AA).¢ 1

(b) Financial certification period. The financial certification period is twelve (12) months.

(c) Medical Certification period. The medical certification period is twelve (12) months. Redetermination of medical eligibility by an Oklahoma Department of Human Services (DHS) nurse is:

(1) completed annually in coordination with the annual reauthorization of the member's patient-centered service plan.

(2) completed when documentation is received that supports a reasonable expectation the member may not continue to meet medical eligibility criteria.

INSTRUCTIONS TO STAFF 317:35-17-12

Issued 12-1-18

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

SUBCHAPTER 19. NURSING FACILITY SERVICES

317:35-19-22. Certification for Nursing Facility (NF)

Revised 9-14-18

(a) Application date. The date of the application for NF care is most important in determining the date of eligibility. If the applicant is found eligible for SoonerCare, certification may be made retroactive for any service provided on or after the first day of the third month prior to the month of application and for future months.¢ 1

(b) Time limited approvals for nursing care. A medical certification period of a specific length may be assigned for an individual who is categorically related to Aged, Blind and Disabled or Aid to Families with Dependent Children. This time limit is noted on the system. It is the responsibility of the nursing facility to notify the area nurse thirty (30) days prior to the end of the certification period if an extension of approval is required by the client. Based on the information from the NF the area nurse, or nurse designee, determines whether or not an update of the Uniform Comprehensive Tool (UCAT) is necessary for the extension. The area nurse, or nurse designee, coordinates with appropriate staff for any request for further UCAT assessments.

(c) Certification period for long-term medical care. A financial certification period of twelve (12) months is assigned for an individual who is approved for long-term care.¢ 2

INSTRUCTIONS TO STAFF 317:35-19-22

Issued 12-1-18

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

(2) Non-Online Enrollment members can contact their local Oklahoma Department of Human Services (DHS) county office to obtain a printed version of the card.DHS staff enters the member’s information into the Eligibility tab on the Medicaid Management Information System (MMIS) Extranetand 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 Quest article IICF/IID Authorizations vs. ICF Authorizations for correct level of care coding instructions.