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317:35-5-63.Agency responsible for determination of eligibility

[Issued 07-01-13]

(a) Determination of eligibility by OHCA. OHCA is responsible for determining eligibility for the following eligibility groups:

(1) children

(2) newborns deemed eligible

(3) grandfathered CHIP children

(4) pregnant women

(5) pregnancy-related services under Title XXI

(6) parents and caretaker relatives

(7) former foster care children

(8) Oklahoma Cares Breast and Cervical Cancer program

(9) SoonerPlan Family Planning program.

(b) Determination of eligibility by OKDHS. OKDHS is responsible for determining eligibility for the following eligibility groups:

(1) TANF recipients

(2) recipients of adoption assistance or kinship guardianship assistance

(3) state custody

(4) Refugee Medical Assistance

(5) aged

(6) blind

(7) disabled

(8) Tuberculosis

(9) QMBP

(10) QDWI

(11) SLMB

(12) QI-1

(13) Long term care services

(14) alien emergency services.

(c) Determination of eligibility for programs offered through the Health Insurance Exchange. Effective October 1, 2013, OHCA assesses applicants who are found to be ineligible for SoonerCare for potential eligibility for affordable insurance programs offered through the Health Insurance Exchange. OHCA does not determine eligibility or ineligibility for those programs. OHCA facilitates the determination for those affordable insurance programs by forwarding applicants' electronic applications to the Health Insurance Exchange.

Disclaimer. The OHCA rules found on this Web site are unofficial. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.