Use the Member Tab to ADD individuals to the case, or remove individuals from the case.

• To add another person to the case, click “Add another person”.

Legal Name

• Enter the following information. Fields that are marked with asterisks are required.
  • First Name*
  • Middle Name
  • Last Name*
  • Suffix
  • Date of Birth*
  • Marital Status*
  • Gender*

(If female is selected, you will be instructed to enter “Yes or No” with respect to Pregnancy. If yes, then due date, number of babies expected, and Pregnancy end date will need to be added).*

Requested Benefits

• (Select all that apply.)

SSN

• Enter Social Security Number*
• Re-enter SSN*

Race and Ethnicity

• Race* (check all that apply)
  • American Indian or Alaskan Native
  • Asian
  • Black or African American
  • Native Hawaiian or Other Pacific Islander
  • White
  • Declined to answer
• Is this person of Hispanic or Latino origin (or descent)?-
  Select Yes or No.

• (If Native American / Alaskan Native is selected, enter the following:
  • Primary Tribal Name*
  • Does this person have a Certificate of Degree of Indian Blood (CDB)? Select Yes / No
  • Does this person have a Tribal Enrollment Card? Select Yes / No

Residency and Citizenship

• Resident of Oklahoma* (Select Yes or No)
• Citizenship* (Check appropriate response)
  • U.S. Citizen
  • Alien with documentation
  • None of the above
• Documentation* (Select Documentation Type)

Document Types for U.S. Citizens, Select one of the following:

• U.S. Birth Certificate (Original or Certified Copy)
• U.S. Passport (Original)
• U.S. Naturalization Certificate issued by USCIS
• Certificate of U.S. Citizenship issued by USCIS
• Voter Registration Card
• Native American Citizenship
• Certification or Report of Birth Abroad issued by USCIS or State Dept.
• American Indian card issued USCIS for the Kickapoo tribe
• Final Adoption Decree
• Evidence of Civil Service employment by U.S. Government before 6/1/1976
• Official military Record of Service showing U.S. place of birth
• Bureau of Indian Affairs tribal census records (Navajo & Seneca only)
• Other Public record of U.S. birth

• If Alien with documentation is selected, enter the following:
  • Documentation*
  • Alien Registration Number*
  • US Entry Date*

Document Types for Alien with documentation, Select one of the following:

• Permanent Resident Card (“Green Card”, I-551)
• Reentry Permit (I-237)
• Certificate of Eligibility for Nonimmigrant (F-1) Student Status (1-20)
• Certificate of Eligibility for Exchange Visitor (J-1) Status (DS2019)
• Refugee Travel Document (I-571) or Arrival/Departure Record (I-94, I-94A) with Refugee Stamp
• Employment Authorization Card (I-766)
• Arrival/Departure Record (I-94, I-94A)
• Temporary I-551 Stamp (on passport or I-94, I-94A)
• Machine Readable Immigrant Visa (with temporary I-551 language)
• Unexpired foreign passport
• Notice of Action (I-797)

Alien Documentation

• Refugees bypass the 5 year rule for eligibility. They still have to meet all other requirements.
• Oklahoma residency has no required length of stay, it is declared as long as they intend to stay in Oklahoma.

Alien Coding

• Aliens with no documentation will be coded as: none of the above”
• Aliens with documentation will be coded as any of the following but you will have to know the required information
• If information is not known you can default to “none of the above”.
• If someone is claiming to be an Asylee or Parolee you will code them the same as a refugee.

Parent in Home / Child Support

For each minor in the home, you will be prompted to answer whether or not the other parent of the minor is living in the home.

• If Yes is selected, you will be promted to select parent from list of persons added to the household. If the parent is not listed, use the Add New Person to add them, or change the relationship.
  
• If No is selected, you will be prompted to select the reason the other parent is not in the household.
  • Divorced
  • Legally Separated
  • Separated without court decree
  • Parents deserted
  • Parents not married
  • Parent(s) in prison
  • Parent(s) absent for other reason
  • Death
  • Single Parent Adoption
  • Rights legally terminated

  

• If a reason other than “Death” or “Single Parent Adoption” is selected, the prompt will appear to answer Child Support Question.
  

By selecting YES, the applicant is stating they would like to open or keep open a child support case. They must understand they will be required to provide information to Oklahoma Child Support Services to assist in establishing and/or enforcing child support. They also understand that they must choose this option if they are included in the SoonerCare benefits and at least one of the parents of the child(ren) on their SoonerCare case does not reside in the household.

By selecting NO, the applicant is stating they would like to decline to open a child support case. They understand this option is only available to them if their SoonerCare case has only child(ren) receiving SoonerCare. If they are included in the SoonerCare case, they must choose to open a child support case or request Good Cause.

By selecting I WOULD LIKE TO CLAIM GOOD CAUSE, the applicant is stating they would like to claim Good Cause for refusal to cooperate with Oklahoma Child Support Services. They understand they must prove the non-custodial parent is a danger either to themselves or the child(ren) on their SoonerCare case. They must provide proof (police reports, Victim’s Protection Order, etc.) to show why they are afraid of the non-custodial parent.

Household Questions

• Is anyone in the household blind or disabled?* (Yes or No)
• Is anyone in the household in need of long-term-care?* (Yes or No)
• Is anyone in the household incarcerated (serving sentence in prison or jail)?* (Yes or No)
• Were any of the following members in foster care in Oklahoma on their 18^th birthday?* (Check if applicable)
• Are any of the following members a full-time college student?

• To remove a person from the case, click the +box beside the persons name.

• Click box “Remove this person from the case.

Notes:

• The system should only allow a member to be on one active case at a time. If a member is already on an open case, the member will be moved onto the most current application.
• Unless a minor is emancipated they need to apply with a parent or guardian until they are their own tax household over 19 years old or no longer in the home of a parent.
• It is important to note that married couples (or families that have a child in common and reside together) must be put on the case as a family unit for OHCA.
• To see other requirements for OHCA enrollment visit OHCA- Oklahoma.gov