Oklahoma § 56-1009.2 - Medical coverage for children 18 and under Eligibility - Privately sponsored insurance - Partial coverage Cost-sharing - Rules - Waivers - Funding

§ 56-1009.2. Medical coverage for children 18 and under Eligibility - Privately sponsored insurance - Partial coverage Cost-sharing - Rules - Waivers - Funding

A. On or before January 1, 2011, the Oklahoma Health Care

Authority shall establish and maintain a program with a voucher

and/or other subsidy to provide medical coverage assistance to

children, eighteen (18) years of age or younger, whose family

incomes are between one hundred eighty-five percent (185%) and three

hundred percent (300%) of the federal poverty level.

B. To be eligible for the program, the child must:

1. Be a lawful resident of the State of Oklahoma;

2. Be ineligible for medical assistance under the state

Medicaid program; and

3. Have been without health insurance coverage for a period set

forth by the Authority, but not less than six (6) months during the

first month of operation of the program, except in the following

situations:

a.

loss of employment by a parent which made available

affordable dependent health insurance coverage, until

Oklahoma Statutes - Title 56. Poor Persons

such time as affordable employer-sponsored dependent

health insurance coverage is again available for the

child as set forth by the Authority,

b.

affordable private or employer-sponsored health

insurance is unavailable to the responsible relative

of a newborn, or

c.

loss of medical benefits under the state Medicaid

program within one year of applying for coverage under

the All Kids Act.

C. The Authority shall provide assistance to families in

gaining health care benefits for children in the program by offering

a voucher and/or other subsidy toward the cost of privately

sponsored health insurance, including, but not limited to, employersponsored health insurance provided through the state’s premium

assistance program.

D. If privately sponsored health insurance is not available,

the Authority may allow applicants to purchase access to the stateadministered health care benefit under the premium assistance

program.

E. The Authority is authorized to offer partial coverage to

children who are enrolled in a high-deductible private health

insurance plan or to offer a limited package of benefits to children

in families who have private or employer-sponsored health insurance

coverage which does not cover certain benefits, including, but not

limited to, dental or vision benefits.

F. The families of children who are enrolled in this program

shall be subject to the following cost-sharing requirements:

1. Cost-sharing provisions stated in privately sponsored health

insurance plans for children enrolled in such plans; and

2. Cost-sharing methods and levels to be set forth by the

Authority for individuals participating in the state-administered

premium assistance program. Such cost-sharing shall be on a sliding

scale based on family income and may be periodically modified by the

Authority.

Notwithstanding paragraphs 1 and 2 of this subsection, there

shall be no co-payment required for well-baby or well-child health

care for children enrolled in the program, including, but not

limited to, age-appropriate immunizations as required under state or

federal law.

G. The Authority shall promulgate rules to determine

eligibility and enrollment of children in the program.

H. The Authority shall submit to the federal Centers for

Medicare and Medicaid Services an application for any waivers or any

state plan amendments required to amend the state Medicaid plan to

enact the provisions of the All Kids Act. Subject to federal

approval, the program shall utilize a voucher and/or related subsidy

system for participating families.

Oklahoma Statutes - Title 56. Poor Persons

I. Funding for this act shall be provided from the unused funds

from the Oklahoma Employer/Employee Partnership for Insurance

Coverage pursuant to Section 1010.1 of Title 56 of the Oklahoma

Statutes, not to exceed Eight Million Dollars ($8,000,000.00).

Added by Laws 2007, c. 318, § 2, emerg. eff. June 4, 2007.