Oklahoma Department of Human Services
Sequoyah Memorial Office Building, 2400 N. Lincoln Blvd. • Oklahoma City, OK 73105
(405) 521-3646 • Fax (405) 521-6684 • Internet: www.okdhs.org
 
317:35-17-1. Overview of long-term medical care services; relationship to QMBP, SLMB and other Medicaid services eligibility
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Revised 6-25-12

(a) Long-term medical care for the categorically needy includes:

  • (1) care in a nursing facility (refer to OAC 317:35-19);
  • (2) care in a public or private intermediate care facility for the intellectually disabled(refer to OAC 317:35-9);
  • (3) care of persons age 65 years or older in mental health hospitals (refer to OAC 317:35-9);
  • (4) Home and Community Based Services Waivers for persons with intellectual disabilities (refer to OAC 317:35-9);
  • (5) Personal Care services (refer to OAC 317:35-15); and
  • (6) the Home and Community Based Services Waiver for frail elderly, and a targeted group of adults with physical disabilities age 21 and over who do not have intellectual disability or a cognitive impairment (ADvantage Waiver).

(b) Any time an individual is certified as eligible for SoonerCare coverage of long-term care, the individual is also eligible for other SoonerCare services.  ADvantage Waiver members do not have a copayment for ADvantage services except for prescription drugs.   For members residing in an ADvantage Assisted Living Center, any income beyond 150% of the federal benefit rate is available to defray the cost of the Assisted Living services received.  The member is responsible for payment to the Assisted Living Services Center provider for days of service from the first day of each full month in which services have been received until the vendor pay obligation is met.  Any time an individual is aged, blind or disabled and is determined eligible for long-term care, a separate eligibility determination must be made for Qualified Medicare Beneficiary Plus (QMBP) or Specified Low-Income Medicare Beneficiary (SLMB) benefits. An ADvantage program member may reside in a licensed assisted living facility only if the assisted living center is a certified ADvantage Assisted Living Services provider from whom the member is receiving ADvantage Assisted Living services.

 

Last Updated:  7/11/2012