The following article outlines the process for when an individual applies for Personal Care and is categorically related by being in the Online Enrollment Population Healthy Adult Program (HAP).
During the process, identify if the individual has applied for Personal Care only or both Personal Care and Advantage. The online application for in-home services is for both Personal Care and Advantage. Once determined the individual is applying for Advantage, conduct the interview to determine if LOCEU (level of care) is needed or a referral to HAP.
Hap individuals include:
- A pregnant woman or
- A child under 19 years old, or
- A parent of a child under the age of 19, or
- A caretaker relative of a child under the age of 19
Scenario A
Household consists of a single, pregnant mother with two children. They receive no DHS benefits. All currently receive Medicaid through online enrollment. SPPC application is for mom.
Scenario B
Household consists of a single mother with 16-year-old son. They currently receive SNAP benefits, and the 16 year receives Medicaid through online enrollment. Household income is $1500. SPPC application is for the 16-year-old.
Scenario C
Household consists of 55-year-old grandmother with a 12-year-old grandchild. The receive no DHS benefits. All currently receive Medicaid through online enrollment. SPPC application if for the grandmother.
Further Instructions to Staff
If the case in in application status, check Harmony to ensure that this is a SPPC only request. Then deny it saying needs included in another case D section, the auth line 69 with a hand generated notice. (Review note below.)
For those individuals eligible through HAP, email OHCA at OHCA.ClinicalReviewServices@okhca.org with the following information:
- First and Last Name of Client
- Client DOB
- Client Medicaid ID#
Note: On the line, enter 69 and the D section should indicate “needs included in another case”, which is 22 for now. Remember, any denial for 69 requires an ABCDM-37-C Notice to Client Regarding Long Term Care Medical Care. You will issue the 37C for the ADv/PC line denial stating, “needs included in another case – CMC#” and the customer will also get an automated denial for the D section.
Should you have questions, please staff with your Supervisor and/or Field Manager.
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