{"data":{"id":"us-ok/okla.-stat.-tit.-56-56-247","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 56, § 56-247","heading":"Quarterly review of eligibility – Notice of discrepancy or","body":"change.\n\nA. On a quarterly basis, the Oklahoma Health Care Authority\n\nshall receive and review information concerning individuals enrolled\n\nin Medicaid that indicates a change in circumstances that may affect\n\neligibility, excluding those individuals who would be eligible under\n\nthe Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) and\n\nexcluding those individuals with intellectual disabilities receiving\n\nHome and Community Based Medicaid waiver and state-funded services.\n\nB. The information provided to the Authority shall include, but\n\nis not limited to:\n\n1. Earned and unearned income;\n\n2. Employment status and changes in employment;\n\n3. Residency status;\n\n4. Enrollment status in other state-administered public\n\nassistance programs;\n\n5. Financial resources;\n\n6. Incarceration status;\n\n7. Death records;\n\n8. Lottery winnings; and\n\n9. Enrollment status in public assistance programs outside of\n\nthis state.\n\nC. The Authority shall sign a memorandum of understanding with\n\nany department, agency or division for information detailed in\n\nsubsection B of this section.\n\nD. The Authority shall contract with one or more independent\n\nvendors to provide information detailed in subsection B of this\n\nsection. Any contract entered under this subsection shall establish\n\nannualized savings that exceed the contract's total annual cost to\n\nthe state.\n\nE. The Authority shall explore joining any multistate\n\ncooperative to identify individuals who are also enrolled in public\n\nassistance programs outside of this state, including the National\n\nAccuracy Clearinghouse.\n\nF. Nothing in this section shall preclude the Authority from\n\nreceiving or reviewing additional information related to eligibility\n\nnot detailed in this section or from contracting with one or more\n\nindependent vendors to provide additional information not detailed\n\nin this section.\n\nG. If the Authority receives information concerning an\n\nindividual enrolled in Medicaid that indicates a change in\n\ncircumstances that may affect eligibility, the Authority shall\n\nreview the individual's case using the following procedures:\n\n1. If the information does not result in the Authority finding\n\na discrepancy or change in an individual's circumstances that may\n\naffect eligibility, the Authority shall take no further action;\n\n2. If the information results in the Authority finding a\n\ndiscrepancy or change in an individual's circumstances that may\n\naffect eligibility, the Authority shall promptly redetermine\n\neligibility after receiving such information;\n\n3. If the information results in the Authority finding a\n\ndiscrepancy or change in an individual's circumstances that may\n\naffect eligibility, the individual shall be given an opportunity to\n\nexplain the discrepancy; provided, however, that self-declarations\n\nby applicants or recipients shall not be accepted as verification;\n\n4. The Authority shall provide notice to the individual which\n\nshall describe in sufficient detail the circumstances of the\n\ndiscrepancy or change, the manner in which the applicant or\n\nrecipient may respond, and the consequences of failing to take\n\naction. The applicant or recipient shall have ten (10) business\n\ndays to respond in an attempt to resolve the discrepancy or change.\n\nThe explanation provided by the recipient or applicant shall be\n\ngiven in writing. After receiving the explanation, the Authority\n\nmay request additional documentation if it determines that there is\n\nrisk of fraud, misrepresentation or inadequate documentation;\n\n5. If the individual does not respond to the notice, the\n\nAuthority shall discontinue assistance for failure to cooperate, in\n\nwhich case the Authority shall provide notice of intent to\n\ndiscontinue assistance. Eligibility for assistance shall not be\n\nestablished or reestablished until the discrepancy or change has\n\nbeen resolved;\nis\n\nrisk of fraud, misrepresentation or inadequate documentation;\n\n5. If the individual does not respond to the notice, the\n\nAuthority shall discontinue assistance for failure to cooperate, in\n\nwhich case the Authority shall provide notice of intent to\n\ndiscontinue assistance. Eligibility for assistance shall not be\n\nestablished or reestablished until the discrepancy or change has\n\nbeen resolved;\n\n6. If an individual responds to the notice and disagrees with\n\nthe findings, the Authority shall reinvestigate the matter. If the\n\nAuthority finds that there has been an error, the Authority shall\n\ntake immediate action to correct it and no further action shall be\n\ntaken. If, after an investigation, the Authority determines that\n\nthere is no error, the Authority shall determine the effect on the\n\nindividual's case and take appropriate action. Written notice of\n\nthe Authority action shall be given to the individual; and\n\n7. If the individual agrees with the findings, the Authority\n\nshall determine the effect on the individual's case and take\n\nappropriate action. Written notice of the Authority action shall be\n\ngiven to the individual. In no case shall the Authority discontinue\n\nassistance upon finding a discrepancy or change in circumstances\n\nuntil the individual has been given notice of the discrepancy and\n\nthe opportunity to respond as required under the HOPE Act.","path":["OK Code","Title 56"],"source_url":"https://www.oklegislature.gov/OK_Statutes/CompleteTitles/os56.pdf","current_through":"2026-08-14","vintage":"open-us-law v2026.08, retrieved 2026-09-14","retrieved_at":"2026-09-14T18:32:36Z","sha256":"bb4f4d02d0d209f2341a2b9cc70c0fdb518c6417639bb0b9c5253621e5fa02aa","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-56-56-246","next":"us-ok/okla.-stat.-tit.-56-56-248"},"notice":"GroundRules: Original legal text. Not legal advice."}