Who Qualifies for SoonerCare in Oklahoma?

Individuals aged 65 and older, individuals who are blind or have disabilities, women aged under 65 who need breast or cervical cancer treatment, and soonerplan men and women aged 19 and older with family planning needs are all eligible for this program.

SoonerCare is the brand name given to Oklahoma’s medicaid program. Medicaid is a program that covers medical expenses for certain groups of people who have limited income and resources. The Oklahoma Health Care Authority is the state agency that administers the program.

On June 30, 2020, Oklahomans voted to expand SoonerCare eligibility to adults ages 19-64 whose income is 138% of the federal poverty level or lower through Medicaid expansion. This change equates to an estimated annual income of $17,796 for an individual or $36,588 for a family of four.

SoonerCare, Oklahoma’s Medicaid program, provides health care to children under the age of 19, adults with children under the age of 18, pregnant women, and people who are older than 65 or have blindness or another disability.

In Oklahoma, Medicaid is offered under the name SoonerCare. It provides free or low-cost, high-quality health care services to eligible low-income individuals and families.

Medical care needed due to an accident or medical emergency while a member is travelling in another state is still eligible for compensation once medical necessity is determined. Single-case agreements and contracts will not be allowed under the rule changes.

SoonerCare (Oklahoma Medicaid) is a health coverage program jointly funded by the federal and state government. This program helps pay some or all medical bills for many people who can’t afford them.

What documents do I need to apply for SoonerCare?

Federal Law requires proof of citizenship and identity if the person is applying for SoonerCare for the first time. This flyer explains how to send in that proof. Newborn children (under age one) of SoonerCare members do not have to show proof.

The Oklahoma Health Care Authority administers the SoonerCare (Oklahoma Medicaid) and Insure Oklahoma programs.

SoonerCare provides coverage for dental care, preventive care, family planning services, behavioral health, and substance abuse services as well as inpatient hospital services.

What is the difference between SoonerCare and SoonerPlan?

SoonerPlan is Oklahoma’s family planning program for women and men who are not enrolled in regular SoonerCare services.

The federal government requires that states provide coverage for certain groups of people in order to participate in Medicaid. Low-income families, qualified pregnant women, children, and individuals receiving Supplemental Security Income (SSI) are some of the groups that are mandated to be eligible for coverage.

(A) All inpatient services that are part of a SoonerCare covered stay are subject to post-payment review by the OHCA, or its designated agent.

How long does it take to get approved for SoonerCare?

A. OHCA should complete the enrollment process within four (4) weeks from the receipt of a completed enrollment application, including all required documents.

To start an application for SoonerCare, adults can now visit the website and begin the process. Many adults with or without children may qualify for the program. Children and pregnant women can stay on SoonerCare at higher income levels than most adults. Unemployed or adults with $0 income may also qualify for the program.

Additionally, the SoonerCare Choice/Insure Oklahoma waiver has allowed the state to extend eligibility to include individuals that would not otherwise qualify for coverage including: Adults and full-time college students eligible for Insure Oklahoma with a household income up to 200% FPL.

To apply for Medicaid in Oklahoma, applications can be submitted online, over the phone, or through the mail. To apply online, visit MySoonerCare.org. To apply over the phone, call the SoonerCare Helpline at 800-987-7767.

What is the difference between SoonerCare and Title 19?

Providers will notice the main difference between the two programs when checking eligibility for members. Adults who were not affected by expansion will still show “Title 19” and those with Choice will still show “SoonerCare Choice.” The new expansion population will show “Expansion Healthy Adult Program.”.

SoonerCare will pay for prescriptions written by SoonerCare contracted doctors. If the out-of-state doctor is a SoonerCare doctor, then it will be covered. If they are not a SoonerCare doctor, the prescription will not be covered by SoonerCare.

A variety of other benefits are available to Oklahoma Medicaid recipients, including adult day care, personal emergency response systems, home modifications, and respite care. The Personal Care Program is part of Oklahoma’s state Medicaid plan, and there is no waitlist to receive personal care assistance.

One person in a household: $25,760. Two people in a household: $34,840. Three people in a household: $43,920. Four people in a household: $53,000.

What is the ADvantage program in Oklahoma?

The ADvantage Program is a Medicaid-funded program administered by the Oklahoma Department of Human Services Aging Services Division. The program serves seniors age 65 and older and adults with physical disabilities age 21 and older.

Oklahoma’s most popular plan is the HMO plan. It only covers medical care you use through in-network health providers. Your primary care physician will refer you to specialists within the network. These plans are less expensive than the other types of insurance.

How do I get insurance in Oklahoma?

  • Have 99 or fewer employees;
  • Be located in Oklahoma;
  • Offer a qualified health plan; and.
  • Complete an application packet.

Oklahoma’s healthcare system ranked 50th among 50 states and Washington, D.C. , just ahead of Mississippi at No. 51. Oklahoma ranked 49th last year.

Citations

https://www.benefits.gov/benefit/1638
https://oklahoma.gov/okdhs/services/health/soonercare.html
https://oklahoma.gov/ohca/individuals/mysoonercare/apply-for-soonercare-online/eligibility.html