OKDHS - OAC 340:75-13-80. Determination of medical eligibility

340:75-13-80. Determination of medical eligibility

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Revised 7-1-11

(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 or ineligible aliens are not eligible for medical assistance except in emergency medical situations, regardless of custody status until the child has been lawfully determined to be a permanent resident for five years or otherwise meets federal requirements as a qualified alien. 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 are assigned a custody specialist to ensure the youth have 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 meets eligibility requirements. Per Title 10A of the Oklahoma Statutes, Independent Living Act, youth who were in OKDHS custody and out-of-home placement on their 18th birthday may be eligible to receive medical benefits until their 21st birthday. These youth:
- (A) 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 21st birthday provided all eligibility requirements are met. OKDHS does not pay for services not covered by the Oklahoma Health Care Authority medical 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

Revised 12-15-11

1.   Medical assistance eligibility determination.

(1) Within five business days of the child's removal from the home, the Child Welfare (CW) specialist:

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

(B) opens a KK case and enters all available information in the KK case;

(C) scans the court order that documents the child's removal from the home into the KIDS file cabinet no later than 15 business days following the hearing; and

(D) when the child has no Social Security number, completes and submits Form SS-5, Application for Social Security Number, and scans the document into the KIDS file cabinet to verify the application was submitted, per OAC 340:75-13-10.

(2) The custody specialist:

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

(i) the first day of the month following the child's removal from the home if the child was receiving medical assistance at the time of the removal;

(ii) 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

(iii) the date of removal, if the child was not a medical assistance recipient on the date of removal; and

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

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

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

(i) reviews information from the KIDS case and IMS programs and applications; and

(ii) updates the medical case information.

(B) The CW specialist immediately notifies the custody specialist via email when:

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

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

(I) type of placement;

(II) county of residence;

(III) benefits; or

(IV) health insurance coverage.

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

2.   Acquiring medical or dental care or prescriptions for the unqualified alien child.

(1) When an unqualified or undocumented alien child in OKDHS custody in out-of-home placement:

(A) requires an emergency procedure, the CW specialist consults the custody specialist regarding submission of required documentation to Oklahoma Health Care Authority for approval; or

(B) receives routine medical services, the CW specialist obtains a completed claim from the medical provider and notes unqualified alien child and the child's KK number on the claim and forwards the claim to Children and Family Services Division (CFSD) Administrative Services Unit.

(i) When the unqualified alien child requires medical, dental, vision, or mental health services, the CW specialist mails the original claim form to the CFSD Administrative Services Unit with a coversheet including the:

(I) child's name;

(II) KK number; and

(III) child's unqualified alien status.

(ii) When the unqualified alien child requires prescriptions, the original pharmacy labeling information receipt is mailed to the CFSD Administrative Services Unit with a coversheet that includes the:

(I) child's name;

(II) KK number;

(III) the child's unqualified alien status; and

(IV) the pharmacy name and Federal Employer Identification Number (FEI) or tax identification number.

3.   Youth exiting care.

(1) Youth in OKDHS or tribal custody in an out-of-home placement on his or her 18th birthday are eligible to receive extended Title XIX Medicaid, known in Oklahoma as SoonerCare, as permitted by the Chafee Foster Care Independence Act of 1999. Refer to OAC 340:75-6-110 Instructions to Staff # 11.

(2) 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 human services center.

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