Aged, Blind, Disabled (ABD): Eligibility for Aliens and FACS Coding

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To determine the appropriate category, read the descriptions below to learn what medical benefits that category is eligible for and how to properly code the citizenship blocks. Full scope SoonerCare is provided by programs like QMBP, SSP, Special Medical and all Long-Term Care programs.

 

  • Eligible Alien
    • Lawful Permanent Resident (LPR) whose date of entry into the S. is more than 5 years ago
    • Alien admitted as an Amerasian immigrant
    • Member of a Federally recognized tribe as described in 25 U.S.C.450b(c)
    • American Indian born in Canada to whom section 289 of the Immigration and Nationality Act applies or
    • Lawful Permanent Resident (LPR) who first entered the U.S. under one of the “Eligible Aliens with Special Citizenship Codes” categories below (i.e., Refugee, Asylee, Cuban or Haitian immigrant) and later converted to LPR status
  • Eligible for full scope SoonerCare
  • Coded as “Eligible Alien” in the Citizenship block, enter date client first entered the U.S.
  • People with an LPR status may need to apply to extend with USCIS (U.S. Citizenship and Immigration Status) every 2 or 10 years. It is suggested that a new SAVE be run with every review to ensure their status is up to date.

 

  • Eligible Aliens with Special Citizenship Codes
    • Aliens who fit under these special codes are eligible for full scope SoonerCare
      • Refugee
      • Asylee
      • Cuban or Haitian immigrant
      • Victim of a severe form of trafficking
      • Alien whose deportation is being withheld
      • Alien who is on active duty, other than active duty for training, in the Armed Forces of the United States
      • Alien who is an honorably discharged veteran
      • Spouse or unmarried dependent child of an individual who is in the Armed Forces or is an honorable discharged veteran
    • Eligible for full scope SoonerCare
    • Coded as the applicable Qualified Alien in the Citizenship block, enter date client entered the U.S. with the date client entered the U.S.
      • Anyone in one of the three scenarios below is coded “Qualified Alien-Veterans/Active Military”. (In IMS, F33 will show “M”.)
        • Alien who is on active duty, other than active duty for training, in the Armed Forces of the United States (**M)
        • Alien who is an honorably discharged veteran (**M)
        • Spouse or unmarried dependent child of an individual who is in the Armed Forces or is an honorably discharged veteran
      • For either a Refugee, Cuban or Haitian Immigrant the correct coding is “Refugee”. (In IMS, F33 will show “F”.)
      • An Asylee is coded as “Asylee”. (In IMS, F33 will show an “A”.)
      • An alien whose deportation is being withheld is coded as “Qualified Alien – Deportation Withheld”. (In IMS, F33 will show a “D”.)
      • People from the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau are coded as “Compact of Free Association Immigrant – COFA (Marshall Islands, Micronesia, Palau)

 

  • Iraqi and Afghan Aliens Admitted to the U.S. as Special Immigrants FSS Memo 08-07.
    • The five-year minimum does not apply
    • Eligible for full scope SoonerCare
    • Coded as “Special Immigration Status – Afghan” or “Special Immigration Status – Iraq” with date the client entered the U.S.

 

  • Non-Qualified Aliens (NQA’s)
    • Individuals who were admitted to the United States but do not meet the criteria for “Eligible Alien” or “Eligible Alien with Special Citizenship Codes”, such as a Lawful Permanent Resident (LPR) who has been in the U.S. for less than 5 years
      • This does not include people admitted under a visa (such as for students, tourist, or work)
    • NQA’s are ineligible for full scope SoonerCare for five years from entry in the U.S.
      • NQA’s are eligible for emergency services. The proper citizenship code must show on the case before LOCEU will process a request for emergency services. Please click here for additional steps that must be taken to approve aliens for emergency services other than delivery of newborns.
      • NQA who is pregnant can be eligible for the Soon-To-Be-Sooner program with OHCA.
    • Code as an “Ineligible Alien” with the date the client entered the U.S.

 

  • Undocumented Alien
    • Client has no documentation
    • Client has an expired visa.
  • Undocumented Aliens are ineligible for full scope SoonerCare for five years
    • Undocumented Aliens can be considered for emergency services. The proper citizenship code must show on the case before LOCEU will process a request for emergency services. Please click here for additional steps that must be taken to approve aliens for emergency services other than delivery of newborns.
    • NQA who is pregnant can be eligible for the Soon-To-Be Sooner program with OHCA.
  • Coded as an “Undocumented Alien” with the date the client entered the U.S.

 

  • Ineligible Alien
    • Client is in the U.S. on a visa (examples: temporary or student) for a limited period
    • Client is in the U.S. for a specified period and is not a Lawful Permanent Resident (LPR).
    • Ineligible Aliens are not eligible for full scope SoonerCare nor Emergency Services
      • Effective 04/01/08, ineligible aliens who are pregnant are eligible for the Soon-To-Be-Sooners program.
    • Coded as an “Ineligible Alien” with the date the client entered the U.S.
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