When a minor child loses their SSI benefits, federal law 42 CFR § 435.926 requires that states must provide continuous eligibility to children who are under age 19 and are eligible for and enrolled in a mandatory or optional eligibility group under the Medicaid state plan.

Continuous Eligibility for Children Under Age 19

Children under age 19 who are enrolled in Medicaid receive 12 months of continuous eligibility. Once approved, coverage remains open for the full 12-month period, even if circumstances change.

Example: If a child is approved under the SSI Medicaid group and loses SSI during the 12-month period, the child remains in the SSI Medicaid group until the continuous eligibility period ends.

The 12-month continuous eligibility period begins on the effective date of:

• The child’s initial eligibility approval, or
• The most recent renewal/redetermination.

Coverage Can Only Be Closed Early If:

• The child turns 19.
• The child or representative requests closure.
• The child moves out of Oklahoma.
• Eligibility was granted in error due to agency error, fraud, abuse, or perjury.
• The child dies.

Otherwise, do not close coverage due to changes in income, household composition, resources, or loss of another eligibility factor.

Example:

• A child’s 12-month eligibility period runs from July 1, 2024, through June 30, 2025.
• The child loses SSI in January 2025 (the 7th month of the eligibility period).
• The child stays enrolled in the SSI beneficiary group through June 30, 2025 and should not be terminated or moved because of the SSI loss during the continuous eligibility period.

End of the 12-Month Continuous Eligibility Period

To avoid a dual enrollment denial:

1. Close DHS medical first at the end of the 12-month period.
2. Contact the family and explain the transition.
3. Assist with the OHCA application through AV or FACS.
   • Document in AV: “End of 12 Months Continuous Eligibility for Child/Children Medical requirement.”

Example:

• A child’s 12-month eligibility period runs from August 1, 2024, through July 31, 2025.
• The child loses SSI in August 2025 (the 12th month of the eligibility period).
• The child has already received 12 months of continuous eligibility within the SSI beneficiary group. The ABD case must be closed and the OHCA application through AV or FACS is to be completed.

Results

Once OHCA approves the application:

• The child transitions to OHCA coverage.
• A new 12-month continuous eligibility period begins based on the new approval date.

Quick Reference for Staff

• Children under age 19 receive 12 months of continuous Medicaid coverage.
• Do not close coverage during the 12-month period unless an allowable exception exists.
• Order of operations: Close DHS medical → Submit OHCA application.

Goal: Maintain continuous health coverage without interruption.