Your Comprehensive

SoonerCare

Guide

Published on
February 8, 2024
Last updated
February 8, 2024
Written by
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Katie Wilkinson
Reviewed by
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Quick Overview of SoonerCare

Medicaid in Oklahoma is a joint federal and state program designed to provide health coverage to eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities.

Known as SoonerCare, Oklahoma's Medicaid program aims to ensure that residents with specific income and eligibility requirements can access various healthcare services. These services include primary and preventive care, hospitalization, prescriptions, long-term care, and mental health services.

The Oklahoma Health Care Authority (OHCA) administers the program, which also sets the guidelines for eligibility, covered services, and provider participation.

In recent years, Oklahoma has made significant changes to its Medicaid program, including expanding coverage to more low-income adults following a state ballot initiative. This expansion has increased access to healthcare for many Oklahomans, improving overall health outcomes and reducing the uninsured rate in the state.

Benefits you get with SoonerCare

Medicaid in Oklahoma, or SoonerCare, covers a wide range of healthcare services, each designed to meet the diverse needs of its enrollees. Below are some of the key covered services, along with a brief description of each:

  1. Primary Care Services - Includes routine visits to healthcare providers to prevent, diagnose, and treat illnesses.
  2. Hospital Services - Covers inpatient and outpatient hospital care, including emergency services, surgeries, and other necessary treatments.
  3. Prescription Drugs - Provides access to prescribed medications, with certain restrictions and guidelines, to ensure appropriate and cost-effective treatment.
  4. Dental Services - Includes preventive dental care, diagnostics, and treatment for children and limited emergency procedures for adults.
  5. Vision Services - Covers eye exams and glasses for children and limited vision care for adults.
  6. Behavioral Health Services - Offers mental health and substance abuse treatment services, including counseling, therapy, and medication management.
  7. Long-term Care Services - Provides support for individuals with chronic illnesses or disabilities, including nursing home care and home-based services.
  8. Preventive Services - Encourages regular check-ups, screenings, vaccinations, and other preventive measures to maintain health and prevent disease.
  9. Family Planning Services - Offers access to contraceptive methods, counseling, family planning, and reproductive health education.
  10. Maternity and Newborn Care - Includes prenatal, delivery, and postpartum care for pregnant women and health services for newborns.
  11. Pediatric Services - Covers a broad spectrum of healthcare services for children and adolescents, including well-child visits and immunizations.
  12. Emergency Medical Services - Provides care for acute medical conditions that require immediate attention, regardless of the patient's ability to pay.

These services are designed to ensure comprehensive healthcare coverage for eligible individuals and families under SoonerCare, contributing to the health and well-being of Oklahoma residents.

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SoonerCare eligiblity rules

Eligibility for Medicaid in Oklahoma, known as SoonerCare, is determined based on a combination of factors, including income, age, family size, and specific health needs. The program primarily serves low-income families, pregnant women, children, individuals with disabilities, and the elderly. Below are the specific eligibility levels for various groups, expressed as a percentage of the Federal Poverty Level (FPL):

Children and Adolescents

Children under 19 may qualify with household incomes up to 205% of the FPL.

Pregnant Women

Eligibility extends to pregnant women with household incomes up to 138% of the FPL.

Adults (including Parents and Caretaker Relatives)

Following the Medicaid expansion in Oklahoma, adults aged 19-64 without dependent children are eligible if their household income is up to 138% of the FPL. Parents and caretaker relatives of dependent children qualify with household incomes up to approximately 41% of the FPL, reflecting more stringent criteria for these groups before the expansion.

Individuals with Disabilities and the Elderly:

Eligibility criteria for individuals with disabilities and the elderly typically involve more specific assessments related to medical needs and disability status, in addition to income considerations.

Medically Needy Program

This program allows individuals with significant health needs whose income exceeds the standard Medicaid limits to "spend down" or deduct medical expenses to qualify for coverage.

These income thresholds are subject to change and may be adjusted annually based on federal poverty guidelines. Additionally, eligibility determination also considers assets and other factors for specific populations, particularly older adults and individuals with disabilities. The Oklahoma Health Care Authority (OHCA) provides the most current and detailed criteria for eligibility on its website and through its application process, ensuring applicants receive accurate information tailored to their specific circumstances.

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How to apply for SoonerCare

Applying for Medicaid in Oklahoma can be done through several methods to accommodate different preferences and needs. Here are the specific steps and contact information to help guide you through the application process:

Online Application:

Visit the SoonerCare portal at www.mysoonercare.org. The website provides step-by-step guidance for filling out the application. Make sure you have all necessary information, such as income verification, identification, and residency documents, readily available.

In-Person Application:

Apply in person at a local Oklahoma Department of Human Services (OKDHS) office. Visit the OKDHS website or contact the OKDHS hotline to find the nearest office location and hours. Bring all required documents with you, including proof of income, identity, Oklahoma residency, and any other pertinent information that verifies your eligibility.

Application by Mail or Fax:

Download and print the application form from the OHCA or OKDHS website. Complete the application thoroughly and mail or fax it to the address or number provided on the form.

Phone Application:

Dial the SoonerCare Helpline at 1-800-987-7767 to apply over the phone with the assistance of a representative. The helpline is available Monday through Friday during business hours. Have all necessary information on hand before calling, as the representative will ask questions regarding your income, household size, and other eligibility criteria.

Community health centers and non-profit organizations across Oklahoma may also offer assistance with the application process. Contacting your local community center can provide you with additional support and guidance.

By choosing the most suitable application method for your situation and preparing all required documents beforehand, you can ensure a smoother application process for SoonerCare in Oklahoma.

How to renew SoonerCare

Medicaid coverage in Oklahoma requires annual renewal to verify eligibility. The Oklahoma Health Care Authority (OHCA) will review your situation to ensure you still meet the eligibility criteria.

Renewal Notification

OHCA will send you a notice informing you that it's time to renew your coverage before your renewal date. This notification will typically arrive by mail and may include instructions on completing your renewal process.

Renewal Methods

  • Online: The fastest and easiest way to renew your Medicaid coverage is online through the SoonerCare member portal. Visit www.mysoonercare.org to access your account and complete the renewal process.
  • By Phone: You can call the SoonerCare Helpline at 1-800-987-7767 to renew your coverage over the phone with the help of a customer service representative.
  • Mail or Fax: OHCA may provide a pre-filled renewal form with your notification letter. Review, update, and return this form either by mail or fax. Specific mailing addresses and fax numbers will be provided in your renewal notice or found on the OHCA website.
  • In-Person: To renew your coverage, visit a local Oklahoma Department of Human Services (OKDHS) office in person.

If you need assistance or have questions about the renewal process, you can contact the SoonerCare Helpline at 1-800-987-7767 for direct assistance, or visit the OHCA Website: www.okhca.org for detailed guides and FAQs on renewing your coverage.

Additional programs through SoonerCare

These programs are available to help family caregivers get paid for caring for loved ones on SoonerCare.

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