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Library: Policy

340:75-13-80. Determination of medical eligibility

Revised 9-15-20

(a) Determination of medical assistance eligibility.Determination of eligibility for the state's medical assistance programs is required when a child:

(1) is removed from home and placed in the custody of Oklahoma Department of Human Services (DHS)or a federally recognized Indian tribe when the state is paying for the Indian child's care; or

(2) enters state-paid care by signed parental agreement.  • 1

(b) Unqualified alien child.A child who is an undocumented or unqualified alien is not eligible for medical assistance except in emergency medical situations, regardless of custody status until the child was lawfully determined to be a permanent resident for five years or otherwise meets federal requirements as a qualified alien.  • 2

(c) Child or youth not in DHS or tribal custody and medical assistance.An application for medical assistance may be made on behalf of a child or by a youth not in DHS or tribal custody.  • 3

(1) The child in a family-centered services case must meet eligibility requirements based on the family income to qualify for medical assistance.

(2) A youth in voluntary DHS placement is assigned a custody specialist to ensure he or she has the same medical coverage as a child in DHS or tribal custody.

(3) A youth leaving DHS or federally recognized tribal care who is 18 years of age may receive medical assistance.Per the 2014 Affordable Care Act, a youth in DHS ortribal custody and out-of-home placement on his or her 18th birthday may be eligible to receive medical benefits until his or her 26th birthday.The youth:

(A) must meet eligibility criteria to maintain continuous coverage;

(B) who loses medical coverage may apply online with SoonerCare and receive medical coverage until his or her 26thbirthday provided all eligibility requirements are met. DHS does not pay for services not covered by the Oklahoma Health Care Authority medical program for the youth; and

(C) receiving Supplemental Security Income must apply in the local DHS office.

(4) A pregnant youth 18 years of age or older may apply for pregnancy-related services covered under Title XXI.


Revised 9-15-20

1. Medical assistance eligibility determination.

(1) Within five-business days of the child's removal from the home, the child welfare (CW) specialist:

(A) completes a search of the child and family's Oklahoma Department of Human Services (DHS) history through the Information Management System (IMS);

(B) opens a KK case and enters all available information in the KK case;

(C) scans the court order that documents the child's removal from the home into the Child Abuse and Neglect Information System (KIDS) File Cabinet no later than 15-business days following the hearing; and

(D) provides the child's number or scans proof of application receipt into the KIDS File Cabinet to verify the application was submitted, per Oklahoma Administrative Code (OAC) 340:75-13-10.

(2) The custody specialist:

(A) certifies the eligible child on a C case or H case in Family Assistance/Client Services (FACS) system effective, the:

(i) first day of the month following the child's removal from the home when the child was receiving medical assistance at the time of the removal;

(ii) date Form 04FC007E, Authorization from Parent or Guardian for Voluntary Foster Home Placement and Medical Care of Child, or Form 04IL001E, Voluntary Placement Request, as applicable, was signed; or

(iii) date of removal, when the child was not a medical assistance recipient on the date of removal;

(B) removes the child from any other medical case and updates those cases on FACS with custody information; and

(C) prints Form 04KI072E, Medical Eligibility Determination, from KIDS, signs, and files in the Initial Determination section of the eligibility file.

(3) Each child's medical case is reviewed every 12 months, per OAC 317:35-7-62.

(A) When a review of the medical case is due, the custody specialist:

(i) reviews information from the KIDS case and IMS programs and applications; and

(ii) updates the medical case information.

(B) The CW specialist immediately notifies the custody specialist via email when:

(i) DHS or a tribe no longer has custody of the child; and

(ii) there are changes in the child's:

(I) type of placement;

(II) county of residence;

(III) benefits; or

(IV) health insurance coverage.

(4) The medical case for a child in DHS or tribal paid care is retained in the county of the assigned custody specialist.

2.Acquiring medical or dental care or prescriptions for the undocumented alien child.When an undocumented alien child in DHS custody in out-of-home placement:

(1) requires an emergency procedure, the CW specialist consults the custody specialist regarding submission of required documentation to Oklahoma Health Care Authority (OHCA) for approval; or

(2) receives routine medical services, the CW specialist obtains a completed claim from the medical provider and notes undocumented alien child and the child's KK number on the claim and forwards the claim to Child Welfare Services (CWS) Finance and Business Operations (FBO).

(A) When the undocumented alien child requires medical, dental, vision, or mental health services, the CW specialist mails the original claim form to CWS FBO with a coversheet including the:

(i) child's name;

(ii) KK number; and

(iii) child's undocumented alien status.

(B) When the undocumented alien child requires prescriptions, the original pharmacy labeling information receipt is mailed to CWS FBO with a coversheet that includes the:

(i) child's name;

(ii) KK number; and

(iii) child's undocumented alien status.

3.Medicaid certification for former foster care youth.A youth aging out of foster care is certified for Medicaid without an application or required review.Changes in address or other demographics are reported by the youth to OHCA.

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