Medical services for children in Oklahoma Department of Human Services (OKDHS) custody are paid through a variety of funds.

• (1) Title XIX Medicaid and Children's Special Health Care Needs program.  Title XIX Medicaid, a combination of state and federal money, is administered through Oklahoma Health Care Authority (OHCA).  Medicaid claims are paid from the OHCA budget through a designated fiscal agent.  The Medicaid program:
  • (A) has specific eligibility requirements;
  • (B) covers specific services as determined by Oklahoma's State Plan; and
  • (C) does not pay for experimental procedures.
• (2) Child Welfare medical - special approval.  Children and Family Services Division (CFSD) has limited funds, state monies, that are utilized when the needed service, excluding experimental procedures, is not covered by other medical programs.  Utilization of these funds is considered for approval by CFSD Administrative Services Unit after denial by Title XIX and OHCA.  Only services for children in OKDHS custody and out-of-home placement are eligible for payment from these funds.  All expenditures paid from state funds are paid at the Oklahoma Medicaid compensable amount.
• (3) Child abuse examinations.  When a child abuse examination is warranted, the reimbursement process is dependent upon the child's medical assistance case status on the date of the examination.  If the child is:
  • (A) not a Medicaid recipient and the parent(s) is unable or unwilling to pay for the examination, state funds pay for the examination at established Medicaid rates.  The provider completes claims per OAC 317:30-7-1.  The claim is routed to the county director with an explanation for using state funds; or  • 1
  • (B) a Medicaid recipient and is designated eligible for:
    • (i) fee-for-service, OHCA reimburses for these services at the established rates;
    • (ii) SoonerCare, OHCA reimburses for these services at the established rates with referral from the primary care physician case manager (PCPCM); or
    • (iii) SoonerCare, when the child is examined by a non-PCPCM without a referral from the PCPCM, state funds pay for the examination at established Medicaid rates.  The provider completes claims per OAC 317:30-7-1.  The claim is routed to the county director with an explanation for using state funds.