Information to record in each applicable FACS tab of the Interview Notebook during an application or review interview or prior to taking action on an application or review includes:

1. Case Information tab (All programs): Record that you confirmed the accuracy of the client contact information, the primary language used by the client, and the client’s shelter type. Record any companion case numbers for the household. Record information if the client is participating in the Address Confidentiality Program (ACP).Please note:
   • For Long Term Care (LTC) and aged, blind, or disabled (ABD) clients, especially minors, record the address and relationship of the person who handles the client’s business.
   • Log all calls from clients with information pertaining to eligibility. Case notes should contain the name of the caller and the information they are reporting.
2. Intake tab (All programs at application): Record the application date, interview date, interviewer name, presenting need request, who was interviewed – the client or the authorized representative, how ID was verified, whether the client intends to remain in Oklahoma, and what benefits the client already receives.
3. Household tab (All programs): Record who is currently living in the household, who is requesting benefits, how ID was verified, the citizenship/alien status of those members requesting benefits, and whose income will be considered in determining eligibility. If one or more household members are not being included in benefits, record the reason why.Please note:
   • If the household is applying or receiving food benefits, record who currently purchases and prepares food together.
   • For TANF, when there is an adult non-relative, record whether he or she is considered to be acting in the role of a spouse and why his or her income is or is not being considered.
   • If anyone is not a citizen, record the name of the person, what documents were provided, the alien registration number, the status of the person (lawful permanent resident, refugee, asylee, etc.,), and when the person entered the United States. Record results from Systematic Alien Verification for Entitlement (SAVE).
   • For ABD-related clients, record if the client had medical services in any of the three prior months that need to be considered.
   • For Nursing Facility and ADvantage Assisted Living clients, record the name of the facility where he or she resides.
4. Income tab (All programs): Record what income was declared for each household member, how often income is received, what proof was provided, and what proof is being requested. Prior to taking any case action, record dates and amounts of income, how it was verified, and how it was calculated for each program. Remember to record any deductions or exclusions given to the household. Record declared expenses for self-employment. Use the MICAL transaction to calculate monthly income and paste it into this tab. Record income calculations for each program when countable monthly income is considered differently for one or more programs. For minors related to ABD, copy and paste the results from the CID screen. If you do not use all of the income verification provided in your calculations, document why.Please note:
   • When household members 17 years of age and older are students, record whether earned income is being counted, and how their eligibility was determined.
   • For TANF, when there is an adult non-relative living in the home, record whether he or she is considered to be acting in the role of a spouse and why his or her income is or is not being considered.
   • For SoonerCare (Medicaid), record all recurring and non-recurring lump sum payments.
   • For ABD-related clients, if receiving VA Aid and Attendance, indicate amount and whether it’s being paid to a caregiver.
   • For Nursing Facility care, record calculations for Medicaid Income Pension Trust (MIPT), how much is to remain in trust each month, how much should have accumulated and amount currently in the trust. Record calculations for amount to be diverted to the community spouse and vendor payment.
   • For ADvantage Assisted Living, record vendor payment calculation.
   • For State Supplemental Payment (SSP), record calculations for dividing income between eligible spouses.
5. Expedite tab (SNAP Benefits only): When the client applies for SNAP benefits record whether the client is eligible for expedited services and why. If verification is postponed, record what verification is still needed to certify beyond the initial expedited benefits.
6. Resource tab (SNAP, TANF, and ABD related SoonerCare Medicaid): If the client is applying for benefits in which resources are considered, record all countable resources declared, what documentation was provided and what is still requested. Include any details about the resource that could not be entered in the Resource tab. This may include joint ownership of a resource, details of trust accounts, sale of a resource, etc. Prior to approval or denial of benefits, record which resources are being considered for each program, how they were verified, and how they were calculated.Please note:
   • For SNAP, record the declared amount of liquid resources used in determining expedited eligibility.
   • For ABD-related clients, record how excess resources were spent down. If client has property that is up for sale, record 90-day good faith effort follow-ups. If client had to provide estimates of value of resources, indicate values.
   • For Long Term Care, record date and amount of all transfers of resources. Copy and paste results of the transfer of assets calculator.
   • For Nursing Facility care, if client has home property, indicate if property is exempt and if exempt, why and when exemption will end. Record when lien is filled with Oklahoma Health Care Authority (OHCA).
7. SNAP tab (SNAP benefits only): Record who the client is designating as the authorized representative and as head of household. Also record who purchases and prepares food together, whether anyone in the household is a fleeing felon, on strike, or disqualified from food benefits.
8. ABAWD tab (SNAP benefits only): Record work registration and ABAWD exemptions for each household member. Document that all exemptions were explored. Record previous K months for ABAWD individuals that are not exempt or meeting the work rule. Document any verification to confirm ABAWD eligibility.
9. Deprivation tab (SoonerCare Medicaid, TANF, and Child Care Subsidy): Record what programs the client is applying for, which children are deprived of parental support, whether deprivation is due to the absence, incapacity, death or unemployment of a parent and how this information was verified. Record changes in absent parent information such as a new address or employer as they occur.When deprivation is based on incapacity, record the date medical information requested from the client was received and where it came from, the date Form 08MA022E (ABCDM-80-D), Medical Social Summary, and medical information was sent to the Oklahoma Health Care Authority’s (OHCA) Level of Care Evaluation Unit (LOCEU) and what decision LOCEU made regarding incapacity and the date the decision was made. Record all information received from LOCEU regarding current eligibility, when a review is due, and what medical information will be required at that time. If medical information was not provided, record the date the application was denied or benefits closed.When a client is only applying for SoonerCare (Medicaid) and is not required to pursue child support, an entry must be made in case notes stating that the client does not wish to pursue child support and is not required to in order to receive SoonerCare (Medicaid) benefits.For Child Care Subsidy, record that forms were completed for all children in the household. This includes children in the household that do not receive child care.
10. Child Care tab/ Child Care Service Plan (Child Care Subsidy only): Enter details regarding the date of request and date verification is received for child care. If the begin date of the child care approval is a future date rather than the date verification is received, record why. Record the following information under the headings shown below at application and review, with additions made when clients report changes:Need:First, record the days and hours the parent or caretaker meets the “need factor” such as work, school, training, including travel time and how verified.Second, record the child’s need for care. If the child is school age, record the hours the child attends school. If any care is provided by a friend, relative, or another program such as Head Start, record the days and hours.Please note:
    • If protective/preventive, record why child care is needed and if it will be needed more than 30 calendar days

    Plan Hours:

    Based on the parent or caretaker’s work, school or training schedule and the days and hours the child requires care, record whether full-time, part-time, a combination of full-time and part-time, weekly, or blended unit type is approved.

    Provider:

    Record the name of the child care facility (& contract number) selected for each child. If more than one provider, explain which provider is co-pay exempt.

11. TPL tab (TANF, SoonerCare Medicaid): Record whether the client has insurance coverage for himself or herself, details about the type of insurance and who is covered. If insurance coverage has stopped, record the date of termination of the insurance policy.Please note:
    • For Nursing Facility care, if the person has long-term care insurance, cut and paste email sent to TPL showing details of the insurance.
12. Custody tab (Custody specialists only): record the names of the children in custody and details about their status
13. TANF Work tab (TANF only): Record the TANF Work plan that was developed with the client at application and as changes in the plan occur. Include details of the client’s TANF Work activities such as the begin date, ongoing monitoring, good cause determinations and reasons for closure.
14. Medical tab (SoonerCare Medicaid only): Record who is requesting medical benefits and whether anyone is pregnant or requesting payment of Medicare premiums. For pregnancy, indicate expected date of delivery and expected number of births. Indicate if adult is requesting family planning services.Please note:
    • Record if a child receiving SSI wants services through SSI-DCP.
    • When a cash benefit closes, the disposition of the medical benefit must be recorded here.
    • Record if OHCA Online Enrollment will determine eligibility for the medical benefit.
15. Expenses tab (All programs): Record which expenses the household has that are entered on this tab, which household member has the expense, and whether they have been verified. At certification and review, state which expenses are allowed for each program. Record how legally binding child support payments and/or medical expenses were verified if deduction given.
16. Shelter tab (SNAP benefits only): Record the shelter and utility expenses, the name of the person that pays all or part of the expenses and his or her relationship to the client, the amount paid, and if questionable, how it was verified.
17. Social Services tab (All programs): At the application interview, record whether the client requests any of the listed services and whether a referral was made. Update information in this tab as services are provided or as new requests are made.
18. Other (All programs): Record any other information that does not fit in the other tabs in this area.

Information to record in each applicable FACS tabs of the Eligibility Notebook during an application or review interview or prior to taking action on application or review includes:

1. Medical General tab (SoonerCare Medicaid only): Record action being taken (change, certification, denial), why, and effective date. If an LOCEU decision is required, record the reason and when the next decision will be needed.Please note:
   • For QMBP, Long-Term Care (without SSP) and AFDC-related medical (not in Online Enrollment), record categorical relationship.
   • If person has been approved for DDS waiver, refer to Resource tab in Interview Notebook and address LTC eligibility factors. Record DDS waiver code and date.
   • Elders Web Access: Record when UCAT was entered.
2. Fin. Assistance tab (SoonerCare Medicaid only): Record eligibility for Special Medical status determination.
3. Auth. LT Care tab (SoonerCare Medicaid only): Copy and paste alerts from Area nurse for LTC decisions. When correcting vendor payment or changing begin/end date of authorization, record reason, permission (if needed) to make change, and amount of correct vendor payment.

Information to record in the Narrative portion of case notes at application and review include:

• how the client’s rights and responsibilities were explained and whether the client stated he or she understood them;
• the date action is taken on the case;
• what action is taken;
• what benefits are affected;
• the program differences and what was used to make a decision for each program when the client has applied for or is receiving multiple benefits. In particular, record the income calculations used for SoonerCare (Medicaid) if different from food benefit and/or child care benefit income calculation and explain why some household members are included in some but not all benefits that the household is receiving; and
• circumstances and reasons any overpayment claim was established, including corrected income, household composition, etc. Include any information you used in determining who was at fault (agency or client) for the overpayment such as DXD screens, Oklahoma Child Support Services (PCSS) screens or Office of Inspector General (OIG) information, as well as any actions you might have taken in an effort to obtain correct household information such as dates and forms sent [for example, an 08AD092E (ADM-92)]

Information to record in the applicable FACS tabs and Narrative when changes are reported between application and review include:

• what change occurred, the date the change occurred, and who reported the change;
• how information was verified, if required;
• what action was taken and the effective date of the action;
• what benefits are affected; and
• the program differences and what was used to make a decision for each program when the client is receiving multiple benefits.