The medical eligibility for non-disabled children, non-disabled adults with children and pregnant women (aka SoonerCare) is now determined through the Oklahoma Health Care Authority’s (OHCA) Online Enrollment system. The medical eligibility for persons in this population can no longer be approved on OKDHS cases. If a person in this population applies for medical at an OKDHS office or via OKDHS Live, it is necessary to convert their application for medical services to the OHCA Online Enrollment system using FACS and OHCA “Agency View.”

Open the OKDHS case in FACS. Update information in FACS tab by tab. There are some FACS tabs which must be coded in a specific way in order for the FACS to Online Enrollment conversion process to work properly.

On the Household tab in the interview Notebook, every person living in the household must be coded “M/O” for medical benefits. In the Benefit drop down box “Medical Assistance – Title XIX” should be chosen. The entry in the Reason drop down, if there is any, should be deleted by clicking the drop down box and pressing the delete key. In the Effect Date drop down, the date the client applied for medical services should be entered. If the Medical (D) section of the case is already open, today’s date should be entered. It is important to remember that every single person that is a part of the client’s household must be coded M/O – whether they wish to apply for medical for themselves or not.

On the Medical tab in the Interview Notebook, a Yes or No answer should be provided for the question “Does this person want medical services?” The question should be answered Yes or No for each living person living in the client’s household. The question “Is this person pregnant?” should be answered for all females living in the household aged 12 years and older. If a female living in the household is pregnant, the “Month/Day/Year of expected date of delivery”, “Expected Number of Births” and “Are you giving the child up for adoption?” fields should be completed. If a person living in the household wishes to request Family Planning services, the “Family Planning Requested” and “Family Planning Request Date” fields should be completed.

On the Medical Gen tab in the Eligibility Notebook, “Certified or Online Enrollment sent to OHCA” (1) must be entered in the Type Action Taken drop down box. A certification action must be entered or the conversion process will not work properly. A change action will not result in a successful conversion. The application date is the day the client applied for medical services with OKDHS. If the D section of the case is already open, today’s date can be entered in the application date field.

The coding in the Child Support Services Requested drop down box can sometimes result in a failed conversion from FACS to Online Enrollment. To ensure a successful conversion, click on the Child Support Services Requested drop down box and then press the delete key on your keyboard.

It is not necessary to enter coding in the Categorical Relationship Indicator fields to successfully convert medical from FACS to Online Enrollment.

On the Medical Fin Tab in the Eligibility Notebook “MEDICAL BENEFITS NOT OTHERWISE LISTED (SUCH AS OHCA ONLINE ENROLLMENT)” should be entered in the Medical Application Reason drop down. “C0 – COUNTY OFFICE” or “OKDHS LIVE” should be entered in the Medical Application Source Drop down, if it has not already been entered.

Click the disc icon to save the case in FACS. You will receive an Online Enrollment Process pop up box with a list of error messages in it. At the top of the pop up box you will see a hyperlink in blue. Before you click the continue button at the bottom of the pop up box, you will need to click on the hyperlink to enter OHCA Agency View.

After clicking on the blue hyperlink, you will be taken to the Agency Identification page in OHCA Agency View. If your Agency and Location are not already populated, please choose the correct entries in the drop down boxes. Click the green Continue button.

The first tab in Agency View is the Members tab. Proceed through each tab to make sure all of the information is correct. Much of the information should already be populated for you, but it is good practice to make sure the fields have been updated with the correct data.
On the Members tab you will need to expand the information for each person in the household and make sure the correct benefits have been selected under the Requested Benefits heading. If a person in the household (such as an employed adult) is not requesting any benefits for themselves, all of the boxes should be unchecked.

On the Absent Parents tab, you will need to make sure to indicate whether or not the client wishes to pursue child support against each of the absent parents on the case. These selections are located under the Support Services heading.

On the Tax Household tab, you will need to indicate the tax filer status for each person in the household. If you do not know the tax filer status, you may select “Non Filer.”

On the Employment and Other Income tabs you will need to make sure all of the household’s income has been included on the case.

On the Expenses tab, you will indicate whether or not the household has any deductible expenses that can be deducted on a Federal Income Tax Return.

The Summary tab is the final tab in Agency View. Check the application date. If the date is not correct, please correct the date and then click the green Update button. Please note that the application date cannot be changed to a date greater than 10 days prior to today’s date. Once you have verified that all of the information on the Summary tab is correct, please click the green Check for Errors button. You may receive error messages. If you do not need to return to the respective tab, correct the errors, and then return to the Summary tab and click Check For Errors again.

Once you have successfully cleared all of the errors on the case, you will be taken to the Submit Application screen. At this point you will need to either select Initial application or Change to existing information. If you are working on an Application for medical, select Initial application. If you are working on a change on an ongoing Online Enrollment case, select Change to existing information. If you select Initial application you will be presented with three additional drop down boxes for Media Type, Signature Type and Signature. Please choose the appropriate selections in each drop down box. Once you have done so, click the green Submit button.

At this point you will be taken to the Provider Selection screen. Please select the desired Primary Care Physician (PCP) for each household member listed. If you do not know which PCP the family desires you may click the next blue Next button at the bottom right and skip the PCP selection. The family will be sent a letter from OHCA telling them that they need to select a PCP.

The Results page will list the eligibility decision for each person in the household.

You may now exit Agency View by clicking the Log Off link at the top right or by simply closing out of the Internet Explorer window or tab. You will then need to return to FACS and click on the Continue button at the bottom of the Online Enrollment Process pop up box. This will continue the save of the OKDHS case in FACS.

After you have completed the save of the case in FACS, you should check the GD screen in IMS. The GD screen should reflect a D section denial (2) action with a reason code of NWD in the D4 field.

At this point the OKDHS case can be cleared and the FACS to Online Enrollment conversion process is complete.