PocketLaw | Oklahoma Statutes | Medical coverage for children 18 and

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

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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 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, employer-sponsored 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 state-administered 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.

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.

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