If an undocumented or non-qualified alien applies for medical assistance, it is possible that they could be approved for Alien Emergency Services to cover the medical bills. The medical benefit will only be open for the days the applicant was in the hospital for a medical emergency.

CATEGORICAL RELATIONSHIPS:

If the alien has children or is a child in the home, determine financial eligibility using the policy at 317:35-10-26 (MAGI rules). NOTE: Alien Emergency Services is an exemption from Online Enrollment and must be processed by DHS.

Use the “Adult Caretaker/Relative w/Child” standards for an adult.

For a child use the “Children and Pregnant Women” standards

SoonerCare and Insure Oklahoma Income Guidelines – 2024

If the alien is over 19 and has no children, then determine eligibility using ABD rules.

Procedure for Approval of Emergency Services

Once all other eligibility factors have been determined, but prior to certification of the case, the following must be sent in an email to LOCEU@okhca.org:

• Client’s name;
• SSN (if available);
• Client ID number;
• Medical information, including history and physical;
• Discharge summary; and
• If a decision on categorical relationship is also needed for the alien, a completed medical social summary, form 08MA022E (ABCDM-80-d), must be sent along with the medical information to the Level of Care Evaluation Unit (LOCEU). Once a favorable decision has been made regarding disability, a separate decision will be made regarding emergency services.

The case should be certified or denied only after both decisions have been entered on the MEDATS (MDL) screen.

Receipt of the medical information will be posted on the MEDATS with an action status of “P” for pending. Once a decision has been reached the MEDATS screen will show either “A” for approved or “D” for denied. If the medical service is approved, the months of eligibility will show on the MEDATS. The certification period can only be for the months that were approved.