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Medicaid in Oklahoma

In 1965, Title XIX of the Social Security Act was enacted to establish Medicaid – a joint federal/state program that enables states “to furnish rehabilitation and other services to help such families and individuals attain or retain capability for independence or self care.” Today, this program provides an entitlement to medically necessary health care to approximately 45 million low income individuals and families and to certain people with disabilities across the country. According to the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS), “Medicaid is the largest program providing medical and health-related services to America’s poorest people.” The “vision” of the Oklahoma Health Care Authority (“OHCA”), is “for Oklahomans to enjoy optimal health status through access to quality healthcare regardless of their ability to pay.”

In Oklahoma, the Medicaid program currently provides certain medically necessary acute health care and long-term care services to more than 600,000 low-income families and elderly individuals and people with disabilities. Children and youth under the age of 21 account for nearly 67% of the Medicaid population, while people with disabilities make up approximately 22% of the total Medicaid population.

For a summary of the Oklahoma Medicaid system, click here.

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EPSDT — OHCA Publication

EPSDT — Fact Sheet, October 2008, by Jane Perkins, JD

EPSDT — Wraparound Services

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TEFRA Children Overview

TEFRA (Tax Equity and Fiscal Responsibility Act of 1982) gives states the option to make Medicaid benefits available to children with physical or mental disabilities who would not ordinarily be eligible for Supplemental Security Income (SSI) benefits because of their parent’s income or resources. This option allows children who are eligible for institutional services to be cared for in their homes.

TEFRA Eligibility

To be eligible, a child must meet the following requirements:

  • Be under age 19;
  • Meet the Social Security definition of disability;
  • Have qualifying income and resources;
  • Meet an institutional level of care. The three levels are: intermediate care for the mentally retarded, nursing facility, or hospital;
  • It must be appropriate to care for the child at home;
  • The estimated cost of caring for the child at home cannot exceed the estimated cost of caring for the child in the institution.

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Resources on Medicaid:

thedesktab

MEDICAID REFERENCE DESK

Bazelon logo-float

TEAMING UP:  USING IDEA AND MEDICAID TO SECURE COMPREHENSIVE SERVICES FOR CHILDREN, a publication of Bazelon Center, 2003, download by clicking here

advguide
ADVOCATE’S GUIDE TO THE MEDICAID PROGRAM
To order a book click here

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