Determining Categorical Relationship
To be eligible for SoonerCare/Medicaid Long-Term Care services an individual must first meet the description of a member eligibility group as shown below. Categorical relationship to disability or blindness is established by the Social Security Administration (SSA).
An individual who is not ABD-related meets the categorical relationship requirement if s/he is receiving TANF or is in OHCA’s online enrollment population. Online enrollment population would include pregnancy or caretaker relative of minor child within specified degree of relationship. OHCA online enrollment eligibility can be verified through MMIS using the clients name and Social Security Number or by checking iCE eligibility.
For Nursing Home an individual must be:
- Aged (65 or older) or
- Disabled or blind as defined above
- Non-ABD as defined above (Both Online Enrollment and TANF individuals must establish an ABD categorical relationship within the first year of eligibility).
For ADvantage Waiver an individual must be ABD related:
- Aged (65 or older) or
- Age 19 or older if physically disabled and not developmentally disabled, or
- Developmentally disabled between the ages of 19 and 65 and does not have an intellectual disability or a cognitive impairment related to the developmental disability
Refer to article Level of Care Evaluation Unit (LOCEU) regarding requests for categorical relationship determinations.
Comments or Suggestions?
We want Quest to be your source for important information that you need to succeed at in your work but we need your help:
Was this article helpful? Was it missing something you needed to get the job done?
Tell us what you think, what you know about this article. What are we doing well, and what we could do better.
All fields are required.