When processing medical and State Supplemental Payment (SSP) applications, the first thing to check is if the client meets a categorical relationship (Aged, Blind, or Disabled). To qualify for SSP, a client must either receive SSI or otherwise meet the income and resource standards but under the SSP standard (see Appendix C-1, Schedule VII.C). If they don’t, we generally deny the application in FACS and help them apply through the Oklahoma Health Care Authority (OHCA) via Agency View.

What constitutes an application?

An individual may apply for medical benefits in the following ways:

• Complete a PS-1, FSS-1 and FSS-1-B form; Spanish Request: PS-1, FSS-1, FSS-1-B
• Online application through OKDHSLive! Website

If an individual applies for Medical through the OKDHSLive! Website it is considered an application for all ABD related programs. Example: SSP, SLMB, ADvantage, etc. Worker should discuss eligibility for all medical benefits with the client during the mandatory interview for medical.

A MS-MA-5 form can be sent to the DHS office from the hospital, but the client or an authorized representative will need to complete a PS-1, FSS-1 and FSS-1-B form, or apply online through OKDHSLive!, in order for the request to be considered an application.

Handling Medical & SSP Applications

The Main Rule: Every applicant must meet a Categorical Relationship (Aged, Blind, or Disabled). If they don’t meet one of these, deny them in FACS and help them apply for health coverage through OHCA Agency View.

Here is a simplified breakdown of common scenarios:

Scenario 1: Pending Disability (No SSI Decision)

• The Situation: Client claims disability but hasn’t applied for SSI yet, or the status is “H80” (pending).
• What to do: Deny the Medical and SSP in FACS. Help them apply via Agency View.
• Backdating Rule: If they are approved for SSI later, they must re-apply for SSP. However, you can use the original application to backdate Medical if it was originally denied for “disability not determined” and OHCA didn’t cover them.

Scenario 2: No Income (Age 65+)

• The Situation: Client is 65+ but has zero income
• What to do: Deny the SSP as there is no income to supplement. However, you can certify them for Medical (QMBP) if they meet all other eligibility rules.

Scenario 3: Limited Income (Age 65+)

To qualify for SSP, a client must either receive SSI or otherwise meet the income and resource standards under the SSP standard (see Appendix C-1, Schedule VII.C).

• The Situation: Client is 65+, hasn’t applied for SSI but has other income under the SSP Standard.
• What to do: You can no longer require them to apply for other benefits per CFR 435.608 i.e. SSI, therefore the SSP can be certified with the medical if they otherwise meet the income and resource standards.

Scenario 4: Denied by SSI for Income

• The Situation: SDX shows SSI denied them because they make too much (e.g., $980–$990/month).
• What to do: Deny the SSP and Medical in FACS. At this point, no categorical relationship is established. Help them apply via Agency View

Scenario 5: Approved for RSDI (Waiting for Payments)

• The Situation: Social Security approved the client for $1,200/month, but payments don’t start for 6 months.
• What to do: Use TPQYC in IMS to check the BEN screen for approval details. Certify the Medical benefit under QMBP. The system will alert you via a G1DX edit when the actual money starts hitting.

Scenario 6: TEFRA Requests for Children

• The Situation: A parent wants to apply for TEFRA for a child.
• What to do: First, check if the child qualifies for regular ABD medical. If they don’t, deny the application. Then, have the family contact the TEFRA unit directly at tefrafax@okhca.org  or 405-522-7752 to get an application packet.