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OKDHS Home > Library > Policy > OAC 317 > Chapter 35. Medical Assistance for Adults and Children - Eligibility > 6. SoonerCare Health Benefits for Categorically Needy Pregnant Women and Families with Children > 35. General eligibility consideration; categorically related family members
317:35-6-35. General eligibility consideration; categorically related family members
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Issued 1-1-99


     

     Financial eligibility for SoonerCare Health Benefits for Pregnant Women and Families with Children is determined using the rules on income according to the category to which the individual is related. (See Part 5, Subchapter 5 of this Chapter.) Unless questionable, the income of categorically needy individuals who are categorically related to AFDC does not require verification.   •1      There is not a resource test for individuals categorically related to AFDC or pregnancy related services.

  • (1) When medical assistance is requested on behalf of any individual, eligibility is determined for that individual as well as all other individuals in the family unit who are categorically related.   •2       In instances where individuals in a family unit are categorically related to different categories, the sequence for determining financial eligibility is as follows:
    • (A) First, eligibility must be established for the individual categorically related to ABD (see OAC 317:35-5-7).
    • (B) Second, financial eligibility is determined for family members who are categorically related to AFDC and/or pregnancy-related services.
  • (2) Income is evaluated on a monthly basis for all individuals included in the case for Health Benefits

INSTRUCTIONS TO STAFF 317:35-6-35

  1. Workers must review the data exchange screens on all Medicaid applications. If there appears to be conflicting information, the worker interviews the applicant to determine if income verification is necessary.

  2. Once eligibility has been established for each of the individuals, a single case record is maintained with all eligible persons coded on the computer system under the family case. See OAC 317:35-7-60(5) for procedures for a family case.

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Last Updated:  10/25/2008
Oklahoma Department of Human Services
Street address: Sequoyah Memorial Office Building, 2400 N. Lincoln Blvd., Oklahoma City, OK 73105
Mailing address: P.O. Box 25352, Oklahoma City, OK 73125
(405) 521-3646
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