OKDHS.org - OAC 340:75-13-80. Referral to the custody specialist for determination of medical eligibility

Calendar | Help | Contact Us | About this Site

Library: Policy

340:75-13-80. Referral to the custody specialist for determination of medical eligibility

<< Back

Next >>

Revised 6-1-07

(a) Determination of eligibility. Determination of eligibility for the state's medical assistance programs is required when a child:

(1) is removed from home and placed in the custody of Oklahoma Department of Human Services (OKDHS), or a federally recognized Indian tribe when the state is paying for the Indian child's care; or
(2) enters state paid care by parental agreement. • 1

(b) Ineligible aliens. Undocumented, ineligible, or illegal aliens are not eligible for medical assistance except in emergency medical situations, regardless of custody status. If a child in OKDHS custody and out‑of‑home placement:

(1) requires an emergency procedure, the Child Welfare (CW) worker consults the custody specialist about submitting required documentation to Oklahoma Health Care Authority for approval; or
(2) receives routine medical services, the CW worker obtains a completed claim from the medical provider and notes ineligible alien and the child's KK number on the claim and forwards the claim to Children and Family Services Division Administrative Services Unit.

(c) Children not in OKDHS or tribal custody. Children not in OKDHS or tribal custody may apply for medical assistance.

(1) Children involved in Family-Centered Services cases must meet eligibility requirements based on the family income.
(2) Youth in voluntary OKDHS placement must notify the person taking the application of their status so they may retain the same medical coverage as children in OKDHS or tribal custody.
(3) Youth leaving OKDHS or federally recognized tribal care who are 18 years of age may receive medical assistance if their income is at or below 185% of the federal poverty level. Per Section 7004-1.6 of Title 10 of the Oklahoma Statutes, Independent Living Act, youth who were in OKDHS custody and out-of-home placement on their 18^th birthday may be eligible to receive medical benefits until their 21^st birthday. These youth:
- (A) are managed care recipients and must meet eligibility criteria and re-apply for medical coverage every six months to have continuous coverage; and
- (B) who lose medical coverage for lack of making timely application may apply for and receive medical coverage until their 21^st birthday provided all eligibility requirements are met. OKDHS does not pay for services not covered by the OKDHS managed care program. • 2
(4) Pregnant youth 18 years of age or older may apply for medical assistance as the medical programs are extended for pregnancies.

INSTRUCTIONS TO STAFF 340:75-13-80

Instructions to Staff Revised 6-1-07

1. (a) Within five working days of the filing of a petition that results in the child's removal from the home, the Child Welfare (CW) worker:

(1) completes a search of the child's and family's Oklahoma Department of Human Services (OKDHS) record history through Information Management System (IMS);

(2) opens a KK case and completes all available information in the KK case;

(3) submits to the custody specialist the court order removing the child from the home; and

(4) submits Form SS-5, Application for Social Security Number, to verify an application was submitted, if the child has no Social Security number, per OAC 340:75-13-10.

(b) The custody specialist prints Form 04KI002E, Eligibility Determination, and:

(1) certifies the eligible child on a C case or H case in Family Assistance/Client Services (FACS) system effective:

(A) the month the petition was filed;

(B) the date Form 04FC007E, Authorization from Parent or Guardian for Voluntary Foster Home Placement and Medical Care of Child, or Form 04IL001E, Voluntary Placement Request, as applicable, was signed; or

(2) removes the child from any other medical case and updates those cases on FACS with custody information.

(d) Each child's medical case must be reviewed every 12 months, per OAC 317:35-7-62.

(1) When a review of the medical case is due, the custody specialist:

(A) may notify the CW worker of the review using an intraoffice form or e‑mail;

(B) uses information from the KIDS case and IMS programs and applications; and

(2) The CW worker is responsible for immediately notifying the custody specialist via e-mail when:

(A) OKDHS or a tribe no longer has custody of the child; and

(B) there are changes in the child's:

(i) type of placement;

(ii) county of residence;

(iii) benefits;

(iv) family's income; or

(v) health insurance coverage.

(e) The medical case for a child in OKDHS or tribal paid care is retained in the county of the assigned custody specialist.

2. Youth exiting care. The custody specialist removes the exiting youth from medical coverage at the time the youth leaves OKDHS custody and out‑of‑home placement. The youth may apply for medical coverage at the local OKDHS office.

<< Back

Next >>