SoonerCare Medicaid

SoonerCare is the Oklahoma Medicaid program for low-income residents who are also uninsured. The program provides free and low cost health care services to those who qualify, including a comprehensive health plan for no monthly fee, though copays may apply for certain types of care. Coverage includes physician care, hospital services, and pharmacy benefits, as well as special types of care and supplies for those with disabilities or other health needs. If you are a resident of Oklahoma and meet the income guidelines for your eligibility group, which usually depends on age and health, you may be able to receive health benefits through SoonerCare.

Pregnant women and children are the most commonly covered category, as the income guidelines are much higher for these individuals. Maternity care through Medicaid is a temporary source of coverage for many pregnant women in Oklahoma to get them through the duration of their pregnancy and delivery in good health. Other eligible groups include low income parents, Medicare recipients who need help paying their health care bills, and SSI beneficiaries. Services are also available for those who need family planning resources or treatment for breast or cervical cancer.

 

SoonerCare Eligibility

Depending on your income and which group you belong under, you may be able to qualify for SoonerCare. You must also be uninsured to qualify, which means having no access to employee benefits, COBRA, or short-term health insurance in the preceding months before you enroll for Medicaid.

 

Current Federal Poverty Level

 

Pregnant Women 185%

Family of 2: $2,333 monthly, $27,991 yearly

Family of 3: $2,943 monthly, $35,317 yearly

Family of 4: $3,554 monthly, $42,643 yearly

Family of 5: $4,164 monthly, $49,969 yearly

 

Children Ages 0-5 133%

Family of 1: $1,238 monthly, $14,856 yearly

Family of 2: $1,639 monthly, $19,699 yearly

Family of 3: $2,068 monthly, $24,817 yearly

Family of 4: $2,497 monthly, $29,965 yearly

 

Children Ages 6-19  100%

Family of 1: $938 monthly, $11,170 yearly

Family of 2: $1,260 monthly, $15,130 yearly

Family of 3: $1,590 monthly, $19,090 yearly

Family of 4: $1,920 monthly, $23,050 yearly

 

Parent (unemployed) 37%

Family of 1: $344 monthly, $4,133 yearly

Family of 2: $467 monthly, $5,598 yearly

Family of 3: $589 monthly, $7,063 yearly

Family of 4: $711 monthly, $8,529 yearly

 

Parent (employed) 53%

Family of 1: $493 monthly, $5,920 yearly

Family of 2: $668 monthly, $8,019 yearly

Family of 3: $843 monthly, $10,118 yearly

Family of 4: $1,193 monthly, $14,315 yearly

 

Aged, Blind, or Disabled 80%

Single: $739 monthly, $8,868 yearly

*$2,000 Asset Limit

Couple: $1,089 monthly, $13,068 yearly

*$3,000 Asset Limit

 

Nursing Home Services 300% SSI

$2,094 monthly, $25,128 yearly

 

Qualified Medicare Beneficiaries (QMB) 100%

Medicaid covers your premiums, coinsurance, and deductibles.

Single: $938 monthly, $11,170 yearly

Couple: $1,260 monthly, $15,130 yearly

 

Specified Low-Income Medicare Beneficiaries (SLMB) 120%

Medicaid covers your premiums only.

Single: $1,117 monthly, $13,404 yearly

Couple: $1,513 monthly, $18,156 yearly

 

 

 

Covered Benefits

SoonerCare offer comprehensive coverage, which includes all the services you would expect to find in a private health plan, and more for those who need additional types of services. Certain services are only available for children who are enrolled, and other care is limited so that the program is only carrying out medically necessary procedures. Benefits vary depending on the member and the level of care needed, though most typical services are offered to all members, such as preventive care and emergency room visits.

  • Ambulance
  • Case management
  • Chemotherapy and radiation treatment
  • Clinic and Federally Qualified Health Center services
  • Dental care (limited for adults)
  • Durable medical equipment
  • Family planning services and supplies
  • Hemophilia
  • Home health care
  • Hospitalization
  • Inpatient mental health care for the elderly
  • Intermediate Care Facilities for those with intellectual disabilities
  • Laboratory and X-ray
  • Maternity care
  • Medical supplies and equipment, including diabetic supplies
  • Mental health care
  • Nurse midwife services
  • Outpatient behavioral health and substance abuse treatment
  • Outpatient hospital care
  • Outpatient surgery
  • Prenatal dental care
  • Personal care
  • Physician services
  • Preventive care
  • Podiatry
  • Prescription drugs
  • SoonerRide (medical transport)
  • Transplants
  • Tuberculosis
  • Ultrasounds

 

How to Apply

You can apply online for SoonerCare and also check the status of your application, and find instructions on completing your application correctly and successfully through the Online Enrollment portal. You may also print and fill out a paper application and mail it into the Oklahoma Health Care Authority.

SoonerCare Application – English

SoonerCare Application – Spanish

 

Resources

OHCA SoonerCare

Apply for SoonerCare

Contact SoonerCare

2401 N.W. 23rd Street, Suite 1A
Oklahoma City, OK 73107

800-987-7767

800-757-5979 (TDD)

 

 

Sources:

 

1. Kaiser State Health Facts. “Medicaid & CHIP – Oklahoma.” http://www.statehealthfacts.org/profileind.jsp?cat=4&rgn=38.

2. OHCA. “SoonerCare Benefits.” http://www.okhca.org/individuals.aspx?id=95&parts=11601.