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Oklahoma Administrative Code (Last Updated: March 11, 2021) |
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TITLE 317. Oklahoma Health Care Authority |
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Chapter 35. Medical Assistance for Adults and Children-Eligibility |
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Subchapter 6. Soonercare for Pregnant Women and Families With Children |
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Part 5. DETERMINATION OF ELIGIBILITY FOR SOONERCARE HEALTH BENEFITS FOR PREGNANT WOMEN AND FAMILIES WITH CHILDREN |
SECTION 317:35-6-39. General calculation of countable income for MAGI eligibility groups
Latest version.
- (a) The income that is counted in determining eligibility for an individual is that individual's household income.(b) In order to calculate the countable household income for an individual:(1) Determine who is in the individual's household (see OAC 317:35-6-40 to 317:35-6-43);(2) Identify all sources of income for all household members;(3) Determine whether each source of income is considered for SoonerCare eligibility or is excluded (see Part 6, Countable Income, of this Subchapter);(4) Determine the gross monthly amount of each source of countable income (see Part 6, Countable Income, of this subchapter);(5) Determine whether each household member's income counts toward the household (see 317:35-6-44);(6) Sum the gross monthly amounts of all countable sources of income of all household members whose income is counted;(7) Subtract allowable adjustments to income (see OAC 317:35-6-52); and(8) Compare the result to the income limit for the individual's eligibility group (see SoonerCare Income Guidelines). If the result is equal to or less than the dollar amount of the income limit, the individual is financially eligible.(9) When calculating the percentage of the Federal Poverty Level (FPL) that corresponds to the individual's monthly countable income, subtract 5% from the FPL percentage reached to determine the countable FPL level for the individual. This countable percentage of FPL is compared to the FPL limit for the individual's eligibility group in order to determine whether the individual is financially eligible. This 5% deduction from FPL has already been accounted for in the dollar amounts of the income limits given in the SoonerCare Income Guidelines.(c) If an individual's household income using this methodology is over the income limit for SoonerCare eligibility and that individual's household income using the MAGI household and income-counting methodology used by the Federally Facilitated Exchange (FFE) is less than 100% of FPL, the FFE's MAGI rules, as promulgated by the Internal Revenue Service, are used to determine SoonerCare eligibility in place of the rules in this Chapter. The FFE rules including, but not limited to, those in the following areas may need to be followed in place of the SoonerCare rules in this Chapter:(1) Rules on household composition;(2) Rules on countable sources of income; and(3) Rules on the budget period used to calculate income, i.e. annual income (FFE) versus current monthly income (SoonerCare).