The information below is a guideline for applying for Medicaid-funded skilled or nursing home care in Oklahoma. Policies may change, and additional documentation could be required.

General Overview

The Oklahoma Department of Human Services (DHS) offers Medicaid assistance for nursing home care to individuals who meet financial and medical eligibility requirements under Title XIX.

For more details about nursing homes, visit www.medicare.gov.

Skilled Care Eligibility
To qualify for skilled care, you must:

• Be a U.S. citizen or eligible alien and an Oklahoma resident.
• Have received medical care in a facility for 30 days or less (including hospital stays before skilled care).
• Financial Eligibility standards, please reference Maximum Income, Resource, and Payment Standards, Schedule VI.

If you stay in a facility for more than 30 consecutive days, the financial standards for nursing home care (below) apply.

Nursing Home Eligibility
You must:

• Be a U.S. citizen or eligible alien and an Oklahoma resident.
• Require professional nursing supervision and significant non-professional nursing care.

Eligibility Criteria:

• Be 65 years or older, or
• Be disabled or blind (per Social Security Administration), or
• Be a parent of a minor child, or
• Be under 19 years old.

Financial Standards:

• Please reference Maximum Income, Resource, and Payment Standards, Schedule VIII.B

If income exceeds standard but is less than the maximum indicated in Schedule VIII.B, you may qualify with a Medicaid Income Pension Trust (MIPT). Contact DHS immediately for assistance.

Skilled Care: The MIPT must be set up and funded by the 31st day in care. There is no monthly copayment during skilled care.

Intermediate Care: Funds over the income standard go into the MIPT. Other income is used for facility payments, insurance premiums, or spousal support. Remaining personal allowance: $75/month.

Funds in the MIPT belong to the Oklahoma Health Care Authority (OHCA) and can only be used with DHS approval.

Other Key Considerations

Transfers (Not Applicable to Skilled Care)

If any assets were transferred, deeded, or gifted to another person within the five years before applying for Medicaid and admission to a nursing facility, these transfers must be reviewed. This evaluation determines whether the transfer could affect your eligibility for long-term care benefits.

Home Property (Nursing Home Only):

Your home may or may not count as a resource depending on your situation.

Spousal Impoverishment: Resources and Assets

When one spouse enters a nursing home, the couple's total assets are combined and divided equally. The community spouse (the spouse who remains at home) is allowed to keep a minimum and up to a maximum amount in assets. The current specific amounts for these limits are indicated on Schedule XI of the Maximum Income, Resource, and Payment Standards. To protect the maximum amount, the couple must have at least twice the maximum amount in total assets at the time of nursing home entry.

What counts as assets?
Assets include:

• Savings and checking accounts
• Certificates of deposit
• Trusts, stocks, and bonds
• Mineral rights and property
• Certain life insurance and burial policies
• Any liquid resources available for nursing home care

During the first year, all assets deemed to belong to the nursing home patient must be transferred solely into the community spouse’s name. The family home is not considered an asset if the community spouse resides in it.

Why is this important?
It is crucial to contact the Department of Human Services as soon as nursing home care begins. They can help determine how much the community spouse may retain and how much must be allocated for the nursing care patient’s needs, whether a Medicaid application is submitted at that time.

Application Process:

You don’t need to apply for Medicaid before placement. Inform the nursing home upon admission. The nursing home will submit necessary forms to DHS.

To speed up the process, provide:

1. Proof of income (pay stubs, award letters, etc.).
2. Social Security number and Medicare card.
3. Bank statements (last 60 months).
4. Property details (addresses, deeds, values).
5. Insurance policies and burial plans.
6. Power of Attorney or Guardianship papers.
7. Vehicle titles and amounts owed.
8. Contact information for someone assisting with your application.

The Advantage Program

The Advantage program helps seniors (65+) and adults (19+) with disabilities receive care at home. Services include:

• Case management.
• Personal care and meals.
• Skilled nursing and medical supplies.

To qualify, you must meet both medical and financial criteria as indicated on Schedule VIII.B on the Maximum Income, Resources, and Payment Standards.

A medical assessment will determine if you require nursing home-level care.

How to Apply:

Apply online through the In-Home Assistance Portal.