To be eligible for SoonerCare, an individual must first meet the description of a member eligibility group. For individuals related to the aged, blind, or disabled groups, categorical relationship is established using the same definitions of age, disability and blindness as used by Social Security Administration (SSA) in determining eligibility for Supplemental Security Income (SSI) or Social Security (SSA) benefits.
An individual is related to the aged group when his/her age is established as 65 years or older. The individual meets the relationship to aged for the entire month in which his/her 65th birthday occurs.
For an individual to meet the definition of “blind”, s/he must have a central visual acuity of 20/200 or less in the better eye with the use of a correcting lens. This determination must be made by SSA or OHCA’s Level of Care Evaluation Unit (LOCEU)
For an individual to meet the definition of “disabled” s/he must be unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death, or which has lasted, or can be expected to last, for a continuous period of not less than 12 months. This determination must be made by SSA or OHCA’s Level of Care Evaluation Unit (LOCEU).
A premature infant (i.e. 37 weeks or less) whose birth weight is less than 1200 grams, which is approximately 2 pounds 10 ounces, is considered disabled even if no other medical impairment exists.
Categorical relationship to the disabled is automatically established if an individual dies while receiving a medical service in a hospital or ambulance, or dies as a result of an illness for which he/she was hospitalized if death occurs within two months after hospital release.