Oklahoma § 56-247

§ 56-247.

change.

Quarterly review of eligibility – Notice of discrepancy or

Oklahoma Statutes - Title 56. Poor Persons

A. On a quarterly basis, the Oklahoma Health Care Authority

shall receive and review information concerning individuals enrolled

in Medicaid that indicates a change in circumstances that may affect

eligibility, excluding those individuals who would be eligible under

the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) and

excluding those individuals with intellectual disabilities receiving

Home and Community Based Medicaid waiver and state-funded services.

B. The information provided to the Authority shall include, but

is not limited to:

1. Earned and unearned income;

2. Employment status and changes in employment;

3. Residency status;

4. Enrollment status in other state-administered public

assistance programs;

5. Financial resources;

6. Incarceration status;

7. Death records;

8. Lottery winnings; and

9. Enrollment status in public assistance programs outside of

this state.

C. The Authority shall sign a memorandum of understanding with

any department, agency or division for information detailed in

subsection B of this section.

D. The Authority shall contract with one or more independent

vendors to provide information detailed in subsection B of this

section. Any contract entered under this subsection shall establish

annualized savings that exceed the contract's total annual cost to

the state.

E. The Authority shall explore joining any multistate

cooperative to identify individuals who are also enrolled in public

assistance programs outside of this state, including the National

Accuracy Clearinghouse.

F. Nothing in this section shall preclude the Authority from

receiving or reviewing additional information related to eligibility

not detailed in this section or from contracting with one or more

independent vendors to provide additional information not detailed

in this section.

G. If the Authority receives information concerning an

individual enrolled in Medicaid that indicates a change in

circumstances that may affect eligibility, the Authority shall

review the individual's case using the following procedures:

1. If the information does not result in the Authority finding

a discrepancy or change in an individual's circumstances that may

affect eligibility, the Authority shall take no further action;

2. If the information results in the Authority finding a

discrepancy or change in an individual's circumstances that may

Oklahoma Statutes - Title 56. Poor Persons

affect eligibility, the Authority shall promptly redetermine

eligibility after receiving such information;

3. If the information results in the Authority finding a

discrepancy or change in an individual's circumstances that may

affect eligibility, the individual shall be given an opportunity to

explain the discrepancy; provided, however, that self-declarations

by applicants or recipients shall not be accepted as verification;

4. The Authority shall provide notice to the individual which

shall describe in sufficient detail the circumstances of the

discrepancy or change, the manner in which the applicant or

recipient may respond, and the consequences of failing to take

action. The applicant or recipient shall have ten (10) business

days to respond in an attempt to resolve the discrepancy or change.

The explanation provided by the recipient or applicant shall be

given in writing. After receiving the explanation, the Authority

may request additional documentation if it determines that there is

risk of fraud, misrepresentation or inadequate documentation;

5. If the individual does not respond to the notice, the

Authority shall discontinue assistance for failure to cooperate, in

which case the Authority shall provide notice of intent to

discontinue assistance. Eligibility for assistance shall not be

established or reestablished until the discrepancy or change has

been resolved;

6. If an individual responds to the notice and disagrees with

the findings, the Authority shall reinvestigate the matter. If the

Authority finds that there has been an error, the Authority shall

take immediate action to correct it and no further action shall be

taken. If, after an investigation, the Authority determines that

there is no error, the Authority shall determine the effect on the

individual's case and take appropriate action. Written notice of

the Authority action shall be given to the individual; and

7. If the individual agrees with the findings, the Authority

shall determine the effect on the individual's case and take

appropriate action. Written notice of the Authority action shall be

given to the individual. In no case shall the Authority discontinue

assistance upon finding a discrepancy or change in circumstances

until the individual has been given notice of the discrepancy and

the opportunity to respond as required under the HOPE Act.

Added by Laws 2018, c. 3, § 2.