OKDHS - OAC 340:75-13-75. Out-of-state Medicaid coverage

340:75-13-75. Out-of-state Medicaid coverage

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Revised 6-1-12

(a) Title IV-E eligible. A child certified for Title IV-E in Oklahoma is eligible for Title XIX Medicaid coverage in the child's state of residence when the child is placed in an out-of-state Interstate Compact on the Placement of Children placement, receiving state, with relatives or non-relatives. • 1

(1) The child continues to receive Title XIX Medicaid coverage from the state of residence when the Title IV-E foster care eligibility remains in effect.
(2) A medical plan that provides necessary and expected medical services and payment for those services must be in place before the child in Oklahoma Department of Human Services (OKDHS) custody is sent to reside out-of-state.

(b) Medicaid and Title IV-E ineligible child. A child ineligible for Title IV-E may be eligible for Medicaid from the receiving state, depending on that state's eligibility criteria.

(1) When the receiving state does not provide Medicaid for a child in OKDHS custody who is ineligible for Title IV-E:
- (A) the Oklahoma medical case remains open; and
- (B) the placement provider in the receiving state locates all medical providers the child may need who:
  - (i) are Oklahoma Medicaid providers; or
  - (ii) may become Oklahoma Medicaid providers.
(2) The Oklahoma Health Care Authority (OHCA) assists providers from other states to become Oklahoma Medicaid providers.

(c) Out-of-state medical services. A child in OKDHS custody requiring medical attention while traveling through or vacationing in another state must receive the needed emergency care. When the medical provider is:

(1) an Oklahoma Medicaid provider, the provider files a claim per OAC 317:30-7-1;
(2) not an Oklahoma Medicaid provider, but is willing to become one, the provider is referred to the OHCA Provider Contract; or
(3) not an Oklahoma Medicaid provider and is not willing to become one, the CW specialist contacts Children and Family Services Division Administrative Services Unit for assistance to pay for the medical service provided to the child. • 2

(d) Medical expenses when a child is placed with a parent. When a child in OKDHS custody is placed with a parent, the parent is responsible for the child's medical expenses.

(1) The parent may apply for medical assistance for the child in the parent's state of residence.
(2) The child may receive medical coverage from the receiving state when the family meets that state's eligibility requirements.

INSTRUCTIONS TO STAFF 340:75-13-75

Issued 12-15-11

1. Title IV-E eligibility documentation. The Child Welfare (CW) specialist:

(1) provides Title IV-E eligibility information with the initial Interstate Compact on the Placement of Children (ICPC) request sent to the Children and Family Services Division (CFSD) ICPC deputy compact administrator; and

(2) screen prints the child's Title IV-E eligibility from KIDS and files it in the KK paper case file.

2. Out-of-state medical services. When a child in OKDHS custody requires medical attention while traveling through or vacationing in another state and the medical provider is not an Oklahoma Medicaid provider and is not willing to become one, the CW specialist:

(1) contacts the medical provider to obtain completed universal medical claim forms:

(A) CMS-1500, Health Insurance Claim Form;

(B) Form UB-04; or

(C) Form CMS-1450;

(2) obtains the provider billing information including the provider's name, address, Federal Employer Identification number (FEI), or tax identification number;

(3) provides Children and Family Services Division (CFSD) Administrative Services Unit with an explanation of the circumstances including the:

(A) reason for the child's out-of-state travel;

(B) dates of the child's travel; and

(C) date of the child's medical services; and

(4) mails the original claim form to CFSD Administrative Services Unit.

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