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SoonerCare Choice - Guaranteed Period of Eligibility - Oklahoma

New SoonerCare Choice members receive a period of six months of continuous guaranteed eligibility following completion of the SoonerCare eligibility and enrollment process. The guaranteed period of eligibility is retroactive to the date eligibility is determined for Medicaid. The guaranteed period of eligibility is linked to the member and not the Primary Care Provider and ends if any of the following conditions occur, among others:

· An individual receives services in a nursing facility, in an intermediate care facility for the mentally retarded (ICF-MR) or through a Home and Community Based Waiver

· An individual becomes privately enrolled in a managed care plan

· An individual would be required to travel more than 45 miles or an average of 45 minutes to obtain primary care services, or a greater or lesser distance/driving time as determined by the administration

· An individual lives in or moves to an area excluded from SoonerCare

· A child is in a subsidized adoption

· The State is unable to locate an individual

· A determination is made that an individual has committed fraud related to the Medicaid program

· An error has been made in determining income or determining resources and the person is not eligible for Medicaid services

· An individual is no longer in a group eligible for SoonerCare

· An individual is an illegal or ineligible alien

· An individual's case has been closed due to failure to cooperate with the eligibility determination

· An individual is excluded or terminated from SoonerCare for any reason

· An individual becomes dually-eligible for Medicare and Medicaid

For additional information, see:

OAC 317: 25-7-10 at OK Department of Human Services Policy.

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SoonerCare Choice - Guaranteed Period of Eligibility - Oklahoma

For additional information, see:

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