Topic: Online Enrollment
Link to SoonerCare Benefit Chart
Online Enrollment (OE) – A web-based system developed by the Oklahoma Health Care Authority to determine Medicaid eligibility for certain individuals. Detailed systems information is available under Quest: OHCA Online Enrollment. Policy regarding this term is located at: Public Assistance Procedures (all programs): 340:65-3-1. Determination of eligibility; 340:65-3-6. Cash assistance payment procedures; 340:65-3-8. Continuing eligibility […]
MAGI – acronym for Modified Adjusted Gross Income. Financial eligibility for persons eligible to apply using Online Enrollment (OE) is determined using the modified adjusted gross income on income tax forms. Policy regarding this term is located at: SoonerCare (Medicaid)[OE]: 317:35-5-46. Determination of income and resources for categorical relationship to pregnancy-related services; 317:35-6-1. Scope and […]
Medicaid – is a health insurance program jointly funded by the state and federal governments but managed by the states. This term is used throughout SoonerCare (Medicaid) policy. Chapter 35. Medical Assistance for Adults and Children – Eligibility: 317:35-1-1. Purpose 317:35-1-2. Definition 317:35-1-3. Legal bases Coverage and Exclusions: 317:35-3-1. Payment for Medicaid Eligibility and Countable […]
Eligibility conditions or factors – these are circumstances that must be met in order for a person to qualify for a benefit issued by Adult and Family Services. The factors or conditions vary depending on the program and are almost always based on federal or state statutes governing the program. Policy regarding these terms is […]
Categorically needy – is a SoonerCare (Medicaid) term that means income and when applicable, resources are within the standards for the category to which the individual is related. Policy regarding this term is located at: SoonerCare (Medicaid)[ABD]: 317:35-1-2. Definitions; 317:35-7-38. Financial eligibility of categorically needy individuals related to ABD; 317:35-7-44. Eligibility for TB related services; […]
Categorical relationship – a term used in the SoonerCare (Medicaid) Program that means the individual meets basic eligibility requirements for an eligibility group. An adult must be pregnant, have children under the age of 18 in the home, be 65 years of age or older, or meet the Social Security Administration’s definition for being disabled […]
Determining Categorical Relationship To be eligible for SoonerCare/Medicaid Long-Term Care services an individual must first meet the description of a member eligibility group as shown below. Categorical relationship to disability or blindness is established by the Social Security Administration (SSA). An individual who is not ABD-related meets the categorical relationship requirement if s/he is receiving […]
Sanctions Process