Maximum Income, Resource, and Payment Standards

Appendix C-1   Effective 1/1/2026

Oklahoma Health Care Authority's Online Enrollment system determines eligibility for the groups below. Go to www.okhca.org/ for eligibility information for these groups:

• Children under 19 years of age;
• Parents with minor children;
• Pregnant women;
• Individuals wanting family planning services;
• Women needing treatment of breast or cervical cancer; and
• Adult who do not qualify for Medicare who are between19 and 64 years of age.

Oklahoma Human Services (OKDHS) determines eligibility based on income and resource guidelines displayed in this appendix for persons applying for or receiving:

• Temporary Assistance for Needy Families (TANF) continued medical benefits. Refer to Schedule 1;
• TANF cash assistance and medical benefits. Refer to Schedule IX;
• SoonerCare (Medicaid) benefits for aged, blind, or disabled persons, including long term care services. Refer to Schedules V, VI, VII, VII.A, VIII.B, and XIII;
• State Supplemental Payment cash assistance and medical benefits for aged, blind, or disabled persons. Refer to Schedules VIII.A and VIII.D;
• SoonerCare (Medicaid) for refugees. Refer to Schedule XIV;
• TANF Supported Permanency. Refer to Schedule XVII; and
• Title IV-E eligibility for children in the custody of OKDHS or a federally recognized Indian tribe. Refer to Schedule XV.

Schedule I - Categorically Needy Standards for TANF Continued Medical Benefits

Monthly countable income must be equal to or less than the following income standards, which are 185 percent of the Federal Poverty Guidelines. Resources are excluded in determining eligibility. Refer to Oklahoma Administrative Code (OAC) 340:10-3-75.

For size of family of 9 or more, add $848 per month to monthly income standard for each person over 8.

Schedule II - Revoked

Schedule III - Reserved for Future Use

Schedule IV - Reserved for Future Use

Schedule V - Qualified Disabled and Working Individuals (QDWI)

Monthly countable income and resources must be equal to or less than the following income and resource standards (200 percent of Federal Poverty Guidelines and double Supplemental Security Income (SSI) resource standards). Refer to OAC 317:35-7-41.

Schedule VI - Categorically Needy Standards for Qualified Medicare Beneficiary Plus (QMBP)

Monthly countable income and resources must be equal to or less than the following income and resource standards (100 percent of Federal Poverty Guidelines plus $20 for the general income exclusion) and resource standards (full benefit Medicare Part D low income subsidy resource standards). Refer to OAC 317:35-7-40.

Schedule VII - Specified Low Income Medicare Beneficiaries (SLMB)

Monthly countable income and resources must be equal to or less than the following income and resource standards (120 percent of Federal Poverty Guidelines plus $20 for the general income exclusion) and resource standards (full benefit Medicare Part D low income subsidy resource standards). Refer to OAC 317:35-7-43.

Schedule VII.A - Qualifying Individuals - Group One (QI-1s)

Monthly countable income and resources must be equal to or less than the following income and resource standards (135 percent of Federal Poverty Guidelines plus $20 for the general income exclusion) and resource standards (full benefit Medicare Part D low income subsidy resource standards). Refer to OAC 317:35-7-46.

Schedule VIII - Aged, Blind, or Disabled Individuals

A. State Supplemental Payment (SSP) not living in an institution. Monthly countable income must be less than the following standards.

SSP amount is determined by deducting countable income from the appropriate standard, but cannot exceed $40.

B. Approved for care and living in a nursing facility or Intermediate Care Facility/Individuals with Intellectual Disabilities (ICF/IID). Also includes individuals who receive services through the ADvantage Waiver or other Home and Community-Based Waiver, patients 65 years of age or older in a mental hospital, and children eligibile for services through the Tax Equity and Financial Responsibility Act (TEFRA). Refer to OAC 314:35-5-49, 317:35-9-68, 317:35-17-9, 317:35-19-20.

The average daily cost of nursing home care is $247.72.

1. Monthly countable income must be equal to or less than the Categorically Needy Standard of $2,982 (300 percent of the Federal Benefit Rate). Maximum monthly countable income for a Medicaid Income Pensions Trust cannot exceed $7,535.
2. Monthly maintenance standard are the amount of money the client may retain for his or her own needs.
   • The maintenance standard for individuals residing in a nursing facility or ICF/IID is $75 per month.
   • The maintenance standard for individuals receiving a veteran's reduced pension because of admittance in a nursing facility or ICF/IID is the $90 veteran's reduced pension standard in addition to the $75 nursing facility or ICF/IID maintenance standard.
   • The maintenance standard for individuals who remain approved for care in a nursing facility or ICD/IID since 1973 is $75 per OAC 340:15-1-5.
   • The maintenance standard for individuals residing in an ADvantage assisted living facility is $1,491 (150 percent of the Federal Benefit Rate).

C. Deeming income to blind or disabled minor children. Monthly countable income must be less than the following Federal Benefit Rates.

D. Maximum resources: The resources must be equal to or less than the following standards.

1. Individual - $2,000; Individual and spouse - $3,000.
2. For individuals approved for long term care services, home equity cannot exceed $1,130,000.

E. Student earned income exclusion. Working students younger than 22 years of age may have limited earnings not counted against their SSI benefits. To exclude these earnings, they must be regularly attending a school, college, university, or course of vocational or technical training. Refer to OAC 317:35-5-42(g)(3).

Monthly exclusion - $2,410           Yearly exclusion - $9,730    

Schedule IX - TANF - Emergency Assistance (EA)

Monthly countable income must be less than the following standards. EA monthly payment standards are 50 percent of the TANF payment standard. NOTE: Standards for Refugee Medical Assistance are found on Schedule XIV of this appendix. Refer to OAC 340:10-3-33 and 340:10-19-3.

A. Adults only or adults and children included in the assistance payment.

B. Children only (no adults) included in the assistance payment.

C. Maximum Reserve: The countable reserve must be equal to or less than $2,250 per TANF case. Non-liquid resources, excluding the home and $5,000 equity in one automobile, cannot exceed $2,250. For EA cases, liquid resources available for immediate use cannot exceed the amount needed to meet the emergency.

Schedule X - Revoked

Schedule XI - Income and Resource Standards for the Community Spouse.

Income and resource standards for the community spouse when his/her spouse is in a nursing facility or is receiving servics through the ADvantage Waiver or other Home and Community Based Waiver.

Schedule XII - TANF - Deprivation Based on Unemployment of Parent

The gross income must be at least the following amounts.

A. Base period wage standards for unemployment insurance benefits.

B. Social Security minimum earnings for quarter coverage.

Schedule XIII - Tuberculosis (TB) Infected Individuals

Monthly countable income and resources must be equal to or less than the following income (2 x Federal Benefit Rate + $85) and resource standard.

Schedule XIV - Refugee Medical Assistance

Monthly countable must be less than the following standards. Monthly countable income is defined as the gross unearned income added to the earned income less income exemptions. Earned income exemptions include $90 work related expenses, $30 and 1/3 of the balance. Rules are based on AFDC policy in effort on July 1, 1996. Refer to OAC 340:60-1-6.

A. Child(ren) and one or two adults included in the assistance payment. If there is more than one person in a refugee case, use the AFDC Standard for appropriate number of persons.

B. Children only (no adults) in the assistance payment.

C. Maximum reserve: The countable reserve must be equal to or less than $2,250 per refugee case. Non-liquid resources, excluding the home and $5,000 equity in one automobile, cannot exceed $2,250.

Schedule XIV.A - Refugee Cash Assistance

Monthly countable income must be less than the following payment standard per household size. Refer to OAC 340:60-1-6 for eligibility requirements.

A. The assistance unit may consist of a single adult or an adult, his or her spouse, and all minor children 17 years of age or younger for whom the family assumes financial responsibility.

B. Maximum reserve: The countable reserve must be equal to or less than $2,250 per refugee case. Non-liquid resources, excluding the home and $5,000 equity in one automobile, cannot exceed $2,250.

C. Incentive bonuses: The refugee may receive an early job acceptance bonus of $750 and a job retention bonus of up to $100 per person in the assistance unit when he or she meets eligibility criteria per OAC 340:60-1-6.

Schedule XV - Title IV-E Eligibility for Children in Custody of OKDHS or a Federally Recognized Indian Tribe

Monthly countable income must be less than the NEED standard for size of the household from which the child(ren) was removed. Monthly countable income is defined as the gross unearned income added to the earned income less income exemptions. Earned income exemptions include $90 work related expenses, $30 and 1/3 of the balance. Rules are based on AFDC policy in effect on July 1, 1996.

A. Child(ren) and one or two adults included in the assistance payment.

B. Children only (no adults) included in the assistance payment.

C. Maximum reserve: The countable reserve must be equal to or less than $10,000 per child.

Schedule XVI - TANF Diversion Assistance (DA)

When funds are available, monthly maximum gross income must be equal to or less than the following standards per family size (200 percent of Federal Poverty Guidelines). Child(ren) and one or two adults included in the assistance payment.

Maximum reserve: The countable reserve must be equal to or less than $2,250 per Diversion Assistance case. Non-liquid resources, excluding the home and $5,000 equity in one automobile, must not exceed $2,250.

Schedule XVII - TANF - Supported Permanency

Children only, no adults included in the Supported Permanency Program payment. Refer to OAC 340:10-22-1 and 340:75-6-31.4. The child must be 12 years of age or older or have a sibling 12 years of age or older who resides in the same relative foster home; provided, however, a Child Welfare Services district director may, for good cause, approve a younger child or a sibling of an eligible child.

Schedule XVIII - Family Violence Emergency Assistance and Home-Based Services

Refer to OAC 340:10-1-5 for Family Violence Emergency Assistance and 340:10-19-9 for Home-Based Services rules. The maximum income level for these programs is set at 300 percent of Federal Poverty Guidelines. Approval for this program is based on funding eligibility.

Maximum reserve: The countable reserve must be equal to or less than $2,250 per FVEA case. Non-liquid resources, excluding the home and $5,000 equity in one automobile, cannot exceed $2,250. Refer to TANF resources rules, per OAC 340:10-3-3 through 340:10-3-5.