Medicaid – is a health insurance program jointly funded by the state and federal governments but managed by the states. This term is used throughout SoonerCare (Medicaid) policy.
- Chapter 35. Medical Assistance for Adults and Children – Eligibility:
- 317:35-1-1. Purpose
- 317:35-1-2. Definition
- 317:35-1-3. Legal bases
- Coverage and Exclusions:
- 317:35-3-1. Payment for Medicaid
- Eligibility and Countable Income:
- 317:35-5-1. Scope and applicability
- 317:35-5-2. Categorically related programs
- 317:35-5-3. Determining categorical relationship to the aged
- 317:35-5-4. Determining categorical relationship to the disabled
- 317:35-5-4.1. Special level of care and cost effectiveness application procedures for TEFRA
- 317:35-5-5. Determining categorical relationship to the blind
- 317:35-5-6. Determining categorical relationship to pregnancy-related services
- 317:35-5-6.1 Determining categorical relationship for pregnancy related services under Title XXI
- 317:35-5-7. Determining categorical relationship to the children and parent and caretaker relative groups
- 317:35-5-8. Determining categorical relationship for the SoonerPlan Family Planning Program
- 317:35-5-9. Determining categorical relationship to expansion adults;
- 317:35-5-25. Citizenship/alien status and identity verification requirements
- 317:35-5-26. Residence requirements; residents of public institutions; homeless persons; and residents of HIS, BIA, or Tribal controlled dormitories
- 317:35-5-27. Social Security number
- 317:35-5-40. Scope and applicability
- 317:35-5-41. Determination of capital resources for individuals categorically related to aged, blind and disabled
- 317:35-5-41.1. Home/real property;
- 317:35-5-41.2. Miscellaneous Personal property
- 317:35-5-41.3. Automobiles, pickups, and trucks
- 317:35-5-41.4. Stocks and bonds
- 317:35-5-41.5. Purchases of promissory notes, loans, or mortgages
- 317:35-5-41.6. Trust accounts
- 317:35-5-41.7. Retirement funds
- 317:35-5-41.8. Eligibility regarding long-term care services
- 317:35-5-41.9. Resource disregards
- 317:35-5-41.10. Changes in capital resources
- 317:35-5-41.11. Maximum Resources
- 317:35-5-41.12. Real or personal property essential to self-support;
- 317:35-5-42. Determination of countable income for individuals categorically related to aged, blind and disabled
- 317:35-5-43. Third party resources; insurance, workers’ compensation and Medicare
- 317:35-5-44. Child/spousal support
- 317:35-5-45. Determination of income and resources for children and parents and caretaker relatives
- 317:35-5-46. Determination of income and resources for categorical relationship to pregnancy-related services
- 317:35-5-47. Determination of income and resources for categorical relationship to Disability for TB infected individuals
- 317:35-5-48 Determination of income and resources for categorical relationship to expansion adults;
- 317:35-5-49. Determination of income and resources for categorical relationship to TEFRA
- 317:35-5-60. Application for SoonerCare; forms
- 317:35-5-63. Agency responsible for determination of eligibility
- 317:35-5-64. Cooperation in determination of eligibility
- 317:35-5-65. Notification of eligibility;
- 317:35-5-66. Electronic Notices;
- 317:35-5-67. Returned mail;
- SoonerCare Health Benefits for Categorically Needy Pregnancy Women and Families with Children:
- 317:35-6-1. Scope and applicability
- 317:35-6-15. SoonerCare application for pregnant women, families with children, and expansion adults; forms
- 317:35-6-35. General eligibility consideration
- 317:35-6-36. Financial eligibility of individuals categorically related to AFDC or pregnancy-related services or expansion adults;
- 317:35-6-37. Financial eligibility of categorically needy individuals related to AFDC or pregnancy-related services parent/caretaker relatives, families with children, and expansion adults
- 317:35-6-38. Hospital Presumptive Eligibility
- 317:35-6-39. General calculation of countable income for MAGI eligibility groups
- 317:35-6-40. MAGI household composition; taxpayers and tax dependents
- 317:35-6-41. MAGI household composition; tax filers
- 317:35-6-42. MAGI household composition; exceptions to tax filer rules
- 317:35-6-43. MAGI household composition; non-filers
- 317:35-6-44. Determination of whether a household member’s income is counted
- 317:35-6-50. Countable sources of income
- 317:35-6-51. Exceptions to Internal Revenue Code rules
- 317:35-6-52. Adjustments to income
- 317:35-6-53. Determination of current monthly income
- 317:35-6-55. Treatment of qualified lottery or qualified gambling winnings;
- 317:35-6-60. Certification for SoonerCare for pregnant women and families with children
- 317:35-6-60.1. Changes in circumstances
- 317:35-6-60.2. Retroactive eligibility;
- 317:35-6-61. Redetermination of eligibility for persons receiving SoonerCare
- 317:35-6-63. Denials
- 317:35-6-64. Closures
- 317:35-6-64.1. Transitional Medical Assistance (TMA)
- 317:35-6-65. Transfer of case records between counties
- Medical Services:
- 317:35-7-1. Scope and applicability
- 317:35-7-16. Special application procedure for children in OKDHS custody
- 317:35-7-36. Financial eligibility of individuals categorically related to ABD
- 317:35-7-38. Financial eligibility of categorically needy individuals related to ABD
- 317:35-7-40. Eligibility as Qualified Medicare Beneficiary Plus
- 317:35-7-41. Eligibility as Qualified Disabled and Working Individual
- 317:35-7-43. Eligibility as Specified Low-Income Medicare Beneficiaries
- 317:35-7-44. Eligibility for TB related services
- 317:35-7-46. Eligibility as Qualifying Individuals
- 317:35-7-48. Eligibility for the SoonerPlan Family Planning Program
- 317:35-7-60. Certification for SoonerCare
- 317:35-7-60.1. Certification for the SoonerPlan Family Program
- 317:35-7-61. Redetermination of eligibility for persons receiving ABD or TANF
- 317:35-7-61.1. Special redetermination procedures for TEFRA
- 317:35-7-62. Special redetermination procedures for children in custody or subsidized adoptions
- ICF/MR, HCBW/MR, and Individuals Age 65 or Older in Mental Health Hospitals:
- 317:35-9-1. Overview of long-term medical care services; relationship to QMB, SLMB, and other Medicaid services eligibility, and spenddown calculation
- 317:35-9-4. Services in Intermediate Care Facility for Individuals with Intellectual Disabilities (public and private)
- 317:35-9-5. Home and Community – Based Services (HCBS) Waivers for persons with intellectual disabilities or certain persons with related conditions
- 317:35-9-7. Services for persons age 65 or older in mental health hospitals
- 317:35-9-15. Medicaid recovery
- 317:35-9-25. Application for ICF/MR, HCBW/ID, and persons aged 65 or over in mental health hospitals
- 317:35-9-26. Application procedures for private ICF/MR
- 317:35-9-27. Application procedures for public ICF/MR
- 317:35-9-28. Application procedures for services provided by Developmental Disability Services Division (DDSD)
- 317:35-9-29. Application procedures for persons age 65 or older in mental health hospitals
- 317:35-9-45. Determination of medical eligibility for care in a private Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID)
- 317:35-9-48. Determination of medical eligibility for care in public ICF/MR
- 317:35-9-48.1. Determining ICF/IID institutional level of care for TEFRA children
- 317:35-9-49. Determination of medical eligibility for Home and Community Based Waiver Services for the Intellectually Disabled
- 317:35-9-50. Determination of medical eligibility for persons age 65 or older in mental health hospitals
- 317:35-9-65. General financial eligibility requirements for ICF/MR, HCBW/MR and individuals age 65 or older in mental health hospitals
- 317:35-9-67. Determination financial eligibility of categorically needy individuals
- 317:35-9-68. Determining financial eligibility for care in an ICF/MR (public and private), for HCBW/MR services, and for persons age 65 or older in mental health hospitals
- 317:35-9-75. Certification for long-term medical care through ICF/IID, HCBW/IID services and to persons age 65 and older in a mental health hospital
- 317:35-9-76. Redetermination of financial eligibility for long-term medical care
- 317:35-9-77. Case transfer between categories
- 317:35-9-78. Case changes
- 317:35-9-95. Payment to ICF/MR (public and private)
- 317:35-9-97. Payment for Home and Community Based Waiver services for the Intellectually Disabled (HCBW/ID)
- 317:35-9-98. Payment to mental health hospitals
- 317:35-9-99. Billing procedures for ICF/MR, HCBW/MR services and services for individuals 65 or older in a mental health hospital
- 317:35-9-100. Management of client’s funds while receiving care in NF,ICF/MR (public and private) or for persons age 65 or older in mental health hospitals
- 317:35-9-101. Disclosure of information of health care providers and contractors
- 317:35-9-102. Referral for social services
- 317:35-9-103. Special procedures for release of adults in mental health hospitals to long-term care facilities
- Medical Aid to Families with Dependent Children:
- 317:35-10-10. Capital resources
- 317:35-10-25. Income defined
- 317:35-10-26. Income
- 317:35-10-38. Temporary absence from the home
- Projects:
- 317:35-11-1. Grant and local projects
- Client Rights and Responsibilities:
- 317:35-13-1. Civil rights
- 317:35-13-2. Courteous and prompt action
- 317:35-13-3. Choice of providers
- 317:35-13-4. Release of medical information
- 317:35-13-5. Overpayments
- 317:35-13-6. Fraud
- 317:35-13-7. Program Abuse and Administrative Sanctions
- Personal Care Services:
- 317:35-15-1. Overview of long-term medical care services; relationship to QMBP, SLMB and other SoonerCare services and eligibility
- 317:35-15-2. Personal Care services
- 317:35-15-3. Application for Personal Care
- 317:35-15-4. Determination of medical eligibility for Personal Care
- 317:35-15-5. General financial eligibility requirements for Personal Care
- 317:35-15-6. Determining financial eligibility of categorically needy individuals
- 317:35-15-7. Certification for Personal Care
- 317:35-15-8. Agency Personal Care Service Authorization and Monitoring
- 317:35-15-8.1. Agency Personal Care services; billing; and issue resolution
- 317:35-15-9. Redetermination of financial eligibility for Personal Care
- 317:35-15-10. Redetermination of medical eligibility for Personal Care services
- 317:35-15-12. Case changes
- 317:35-15-13.1. Individual Personal Care service management
- 317:35-15-13.2. Individual Personal Care contractor; billing, training, and problem resolution
- 317:35-15-14. Billing procedures for Personal Care
- 317:35-15-15. Referral for social services
- ADvantage Waiver Services:
- 317:35-17-1. Overview of long-term medical services; relationship to QMBP, SLMB and other Medicaid services eligibility
- 317:35-17-2. Level of care medical eligibility determination
- 317:35-17-3. ADvantage program services
- 317:35-17-4. Application for ADvantage services
- 317:35-17-5. ADvantage program medical eligibility determination
- 317:35-17-9. General financial eligibility requirements for the ADvantage program
- 317:35-17-10. Determining financial eligibility/categorical relationship for the ADvantage program
- 317:35-17-11. Determining financial eligibility for ADvantage program services
- 317:35-17-12. Certification for ADvantage program services
- 317:35-17-14. Case Management services
- 317:35-17-15. Redetermination of eligibility for ADvantage services
- 317:35-17-16. Member annual level of care re-evaluation and annual re-authorization of service plan
- 317:35-17-18. ADvantage services during hospitalization or NF placement
- 317:35-17-19. Closure or termination of ADvantage services
- 317:35-17-21. Case changes
- 317:35-17-21.1. ADvantage and agency Personal Care provider certification
- 317:35-17-22. Billing procedures for ADvantage services
- 317:35-17-23. Disclosure of information of health care providers and contractors
- 317:35-17-24. Referral for social services
- 317:25-17-25. Address Confidentiality Program
- Programs of All-Inclusive Care for the Elderly (PACE):
- 317:35-18-1. Programs of All-Inclusive Care for the Elderly (PACE)
- 317:35-18-2. Introduction
- 317:35-18-3. Definitions
- 317:35-18-4. Provider regulations
- 317:35-18-5. Eligibility criteria
- 317:35-18-6. Program benefits
- 317:35-18-7. Appeals process
- 317:35-18-8. Enrollment
- 317:35-18-9. Continuation of enrollment
- 317:35-18-10. Disenrollment (voluntary and involuntary)
- 317:35-18-11. Data collection and reporting
- 317:35-18-12. Medicaid Payments
- Nursing Facility Services:
- 317:35-19-2. Nursing Facility (NF) program medical eligibility determination
- 317:35-19-3. Services in a Nursing Facility (NF)
- 317:35-19-4. Medicaid recovery
- 317:35-19-5. Application for nursing facility care; forms
- 317:35-19-6. Application procedures for NF
- 317:35-19-7.1. Level of care medical eligibility determination
- 317:35-19-8. Pre-admission screening and resident review
- 317:35-19-9. PASRR screening process
- 317:35-19-14. New admissions, readmissions, interfacility transfers, and same level of care program transfers
- 317:35-19-16. PASRR appeals process
- 317:35-19-18. Change in level of long-term medical care
- 317:35-19-19. General financial eligibility requirements for NF and skilled nursing care
- 317:35-19-20. Determining financial eligibility of categorically needy individuals
- 317:35-19-21. Determining financial eligibility for care in NF
- 317:35-19-22. Certification for NF
- 317:35-19-22.1. Discharge planning
- 317:35-19-23. Redetermination of eligibility for NF care
- 317:35-19-24. Case transfer between categories
- 317:35-19-25. Case changes
- 317:35-19-26. Payment to NF
- 317:35-19-27. Billing procedures for NF
- 317:35-19-28. Management of client’s funds while receiving care in NF
- 317:35-19-29. Disclosure of information on health care providers and contractors
- 317:35-19-30. Referral for social services
- 317:35-19-31. Special procedures for release of adults in mental health hospitals to Nursing Facilities
- Breast and Cervical Cancer Treatment Program:
- 317:35-21-1. Breast and Cervical Cancer Treatment program
- 317:35-21-2. Scope of coverage
- 317:35-21-3. CDC screening
- 317:35-21-4. Creditable coverage
- 317:35-21-5. In need of treatment
- 317:35-21-6. Age requirements
- 317:35-21-7. Citizenship and Residence
- 317:35-21-8. Social security number
- 317:35-21-9. Income
- 317:35-21-10. Resources
- 317:35-21-11. Certification for BCC
- 317:35-21-12. Changes after certification/continued need for treatment
- 317:35-21-13. Redetermination
- 317:35-21-14. Appeals and reconsiderations
- Pregnancy Related Benefits Covered under Title XXI:
- 317:35-22-1. Pregnancy related benefits covered under Title XXI
- 317:35-22-2. Scope of coverage
- 317:35-22-2.1. Non-covered services
- 317:35-22-3. Need for pregnancy related services for the unborn child
- 317:35-22-4. Citizenship
- 317:35-22-5. Social Security number
- 317:35-22-6. Income
- 317:35-22-7. Resources
- 317:35-22-8. Period of eligibility
- 317:35-22-9. Notification of eligibility
- 317:35-22-10. Denials
- 317:35-22-11. Closures
- Living Choice Program:
- 317:35-23-1. Living Choice program
- 317:35-23-2. Eligibility criteria
- 317:35-23-3. Participant disenrollment
- 317:35-23-4. Re-enrollment
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