Is Soonercare Medicare Or Medicaid

Medicare Cost Sharing And Third Party Liability

SoonerCare pays only the deductibles and a portion of the co-insurance when any of the above items are covered by Medicare. OHCA also pays the monthly Medicare Part B premium for SoonerCare members age 65 or older and for certain blind or disabled persons. If an eligible person has other medical insurance, that insurance company must be billed before SoonerCare is billed.

Medicaid Eligibility Expansion Initiative Approved By Voters Took Effect July 2021

Oklahoma Medicaid was expanded as of July 2021, with coverage newly available to non-elderly adults earning up to 138% of the poverty level. More than 291,000 people have gained coverage as a result of Medicaid expansion in Oklahoma.

Although Medicaid expansion had been in the works in Oklahoma since the summer of 2020, the state still benefits from the American Rescue Plans two years of additional federal funding for states that newly expand Medicaid after March 2021. In Oklahomas case, this amounts to about $500 million in additional funding, on top of the 90% funding that the federal government will provide indefinitely for costs associated with the newly eligible population.

In June 2020, voters in Oklahoma passed a Medicaid expansion ballot initiative, paving the way for Medicaid expansion to take effect in Oklahoma. The measure passed by a slim margin, garnering 50.5% of the vote. Oklahoma joined several other states Maine, Utah, Idaho, Nebraska, and Missouri where voters have approved Medicaid expansion ballot initiatives over the last few years, after state lawmakers or governors had rejected Medicaid expansion for several prior years.

Copays And Cost Sharing

A copay is the fee you pay to a provider or pharmacy at the time you receive a service.

Cost sharing is the monthly limit of total copays you will pay. Cost sharing is not a bill. The cost sharing limit is set at 5% of your total income reported to SoonerCare for all members of the household. Once the household cost sharing limit is reached for the month, your household should not be charged a copay that month. Cost sharing starts over every month.

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For More Information About Soonercare

For all questions about SoonerCare, call the Oklahoma Medicaid phone number at 800-987-7767, Monday through Friday, 8 am to 5 pm. There is no 24-hour hotline. If you have a medical emergency, you should call your medical home provider.

You can also visit the Oklahoma Healthcare Authority website for complete SoonerCare information.

The Soonercare Medicaid Office In Oklahoma City Oklahoma

The SoonerCare Medicaid Office is a Medicaid office you can apply at in Oklahoma City, Oklahoma. This facility is funded jointly by the federal government and the state government. You need to legally reside in Oklahoma in order to apply for benefits at this facility. This is because you may only receive Medicaid benefits in your home state. Even though the SoonerCare Medicaid Office is required to follow state and federal guidelines regarding operation, it still maintains autonomy. This means that each Medicaid office in Oklahoma may have rules that are slightly different from one another.

For example, one Medicaid office in Oklahoma City may encourage you to schedule an appointment before you apply for benefits. An office in another city, however, may not. You may use the information below to help you understand which rules you need to follow when you apply for support at the SoonerCare Medicaid Office.

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Whos Eligible For Medicaid In Oklahoma

Under the expanded Medicaid guidelines, adults ages 19-64 whose income is 138% or lower than the federal poverty level are eligible for coverage.

For an individual, that is an income of about $17,796 a year, or $36,588 for a family of four. Heres a breakdown of the maximum monthly income for eligibility by household size:

For more details about eligibility, visit the Oklahoma Health Care Authority website.

How To Contact Soonercare Medicaid Office In Oklahoma

You need to know how to contact SoonerCare Medicaid Office in case you ever need to report to the facility. Even after you apply for Medicaid benefits in Oklahoma, you may need to go to the office to speak with program workers. For this reason, it is important that you know how to contact the SoonerCare Medicaid Office. This Oklahoma City Medicaid office is located at:

SoonerCare Medicaid Office okhca.org Friday 8AM-5PM, Saturday Closed, Sunday Closed, Monday 8AM-5PM, Tuesday 8AM-5PM, Wednesday 8AM-5PM, Thursday 8AM-5PM.

Additionally, remember that you can contact the SoonerCare Medicaid Office by calling . You can also find this Oklahoma City Medicaid office at its official website, okhca.org.

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Oklahoma Health Care Authority

The Oklahoma Health Care Authority is an agency of the government of Oklahoma responsible for providing health insurance benefits for the state’s SoonerCare members. The Authority is the state-level counterpart to the federal Centers for Medicare and Medicaid Services.

The Authority is led by a Board of Directors, composed of seven members appointed by the Governor of Oklahoma, the President pro tempore of the Oklahoma Senate, and the Speaker of the Oklahoma House of Representatives. The Governor appoints the Administrator of the Authority, who serves as the chief executive officer of the Authority, with the consent of the Senate. The Administrator serves at the pleasure of the Governor.

The Authority was created in 1993 during the term of Governor David Walters.

What Does Medicaid Cover In Oklahoma

Under federal law, all states are required to provide the following mandatory Medicaid benefits:

• Inpatient hospital services

• Private duty nursing
• Speech, hearing and language disorder services

The following programs may provide additional services or more restrictions to the services covered above for enrollees.

• Breast and Cervical Cancer Treatment Services
• Family Planning services
• Home and community-based services authorized under a waiver

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What About Managed Care In Oklahoma

The Oklahoma Health Care Authority says the newly eligible adult population will be covered under the SoonerCare Traditional Plan until Oct. 1, when adults approved for benefits through Medicaid expansion will transition to a managed care model called SoonerSelect.

In that shift, those on SoonerCare will choose between plans from four medical insurance companies and three dental insurance companies.

The SoonerSelect medical plans are Blue Cross and Blue Shield of Oklahoma, Humana Healthy Horizons in Oklahoma, Oklahoma Complete Health and UnitedHealthcare.

The dental plans are DentaQuest, LIBERTY Dental and MCNA Dental.

Gov Stitts Alternative To A Medicaid Expansion Ballot Initiative: Soonercare 20 Expansion But With Strings Attached

As described below, Oklahoma submitted a waiver proposal to CMS in December 2018, seeking permission to implement a Medicaid work requirement. But Governor Stitts administration had also been working on a new approach, called SoonerCare 2.0. Instead of the straight Medicaid expansion called for in the ballot initiative that was ultimately approved by voters in 2020, Stitts proposal was significantly more complicated.

In early 2020, the Stitt administration expressed support for the Trump administrations Healthy Adult Opportunity Medicaid waiver approach, and rolled out a proposal designed to take advantage of the new flexibility the federal government is offering states.

SoonerCare 2.0 called for Medicaid expansion as of July 2020, although as noted above, that was canceled as a result of the COVID-19 pandemic. But the second phase of the program, which would have required federal approval and would have taken effect in July 2021, called for premiums for people eligible due to Medicaid expansion, a per-capita spending cap, a waiver of retroactive coverage, and a Medicaid work requirement .

As described above, Stitt surprised lawmakers in May 2020 when he vetoed the bill they had passed that would have provided funding for the SoonerCare 2.0 program that Stitt had proposed. And the state soon withdrew the state plan amendment that called for Medicaid expansion to take effect in July 2020.

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Prescription Drugs With Medicaid In Oklahoma

Prescription drugs that are covered by SoonerCare can be filled at any pharmacy or drugstore that accepts SoonerCare.

For adults, there is a limit of six covered prescriptions per month and your pharmacy must give you a generic drug when one is available. Your doctor may also need to have some prescriptions approved by SoonerCare. Prescriptions for birth control, some drugs for HIV/AIDS, some cancer drugs and some smoking cessation products will not count against your prescription limit. There is a co-payment of $4 for each prescription.

For SoonerCare members younger than 21, there are no limits or co-payments for medically necessary prescriptions.

SoonerCare offers free smoking cessation benefits. Covered products include nicotine patches, gums and lozenges, as well as other pills that combat cravings.

Members can get smoking cessation products as a pharmacy benefit for up to 6 months. Those products will not count toward the monthly limits for members age 21 and older.

For more details, call the Oklahoma Tobacco Helpline at 1-800-784-8669.

Is Soonercare The Same As Medicaid

Medicaid is a great resource for many people to receive health insurance. SoonerCare is the name given to Oklahomas Medicaid program.

How do I check my SoonerCare?

Register If you need assistance with the online application you can call the SoonerCare helpline at 1-800-987-7767 or visit your local Community Action agency.

Is Oklahoma SoonerCare Medicaid?

SoonerCare is a health coverage program jointly funded by the federal and state government.

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Criteria To Be Maintained Before Applying

Applicants must know the following details before submitting an application:

• Your taxable income
• Your spouses taxable income
• Each member of your households Social Security number and date of birth
• Current or current health insurance information
• Identity and citizenship information or alien registration information.
• Income information, including employer name, address, and telephone number, for all employed family members
• Amount of money from other types of income
• Expected due date and number of babies for each pregnant family member
• Current health insurance information for all insured family members, including company name, policy or group number, type of coverage, effective date, name and identity of policyholder
• Most SoonerCare Medicaid members can enroll or renew online. In the absence of Internet access, you may contact your local Oklahoma Department of Social Services, your county public health department, or the Indian Health Center.

Before a SoonerCare Medicaid application is approved, OHCA works with other agencies to perform a comprehensive automated data search on the applicant. OHCA can identify potential red flags even before the application is completed and request accompanying documentation to verify eligibility before membership is granted. Once a candidate is approved for Soonercare, OHCA screens the member daily, weekly, monthly and quarterly to proactively prevent fraud and abuse.

Which Medicare Plan Is Best In Oklahoma

Its extremely important to remember that no plan is created equal. Yes, there might be standardized Medicare supplement plans, but the prices are almost always different.

The way to determine which Medicare plan is best in Oklahoma is to shop your options. By fully shopping your options youll be able to find the best plan that fits you. Below are some considerations for finding which Medicare plan is best in Oklahoma.

• Use the Part D plan finder to enter your drugs to identify the tiers and associated copays.
• Compare the networks of primary doctors and specialists to ensure your doctor is in network
• Understand the additional benefits you may qualify for such as dental, vision, hearing, and wellness.

Once you have gone through that exercise in full, youll be better suited to determine which Medicare plan is best in Oklahoma for you.

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Oklahoma Medicaid Enrollment Numbers

As of April 2022, there were 1,232,438 Oklahoma residents enrolled in SoonerCare, the states Medicaid program. Fifty-five percent of them were children.

For perspective, SoonerCare enrollment stood at 790,051 at the end of 2013, and had been at just under 808,000 as of April 2020. But Medicaid programs all across the country have seen ballooning enrollment since 2020, amid the COVID-19 pandemic, and this was true even in states that hadnt expanded Medicaid under the ACA.

The increased enrollment was partially due to the widespread job losses during the early days of the pandemic. But continued enrollment growth has been driven largely by the Families First Coronavirus Response Act. Under that legislation, all states are receiving additional federal Medicaid funding but on the condition that they not disenroll anyone from Medicaid until the end of the COVID public health emergency . So the normal eligibility redetermination process has been paused since early 2020, with nationwide Medicaid enrollment continuing to grow.

Oklahomas Medicaid enrollment growth has also been driven by the states expansion of Medicaid, which covered more than 291,000 people as of May 2022.

Dual Eligibile Medicare And Medicaid Plans In Oklahoma

The term dual eligible means that people are covered by both Medicare and Medicaid at the same time. In addition to qualifying for Medicaid, people usually qualify for Medicare Part A, Medicare Part B and a Medicare Savings Program that may pay for Medicare deductibles, coinsurance, and copayments.

The four kinds of Medicare Savings Programs are the Qualified Medicare Beneficiary Program, the Specified Low-Income Medicare Beneficiary Program, the Qualifying Individual Program and the Qualified Disabled and Working Individuals Program. To see if you qualify for any of these programs, contact a SoonerCare office.

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Access To Medical Records

OHCA may get medical records for case management purposes directly from SoonerCare contracted medical providers or through contracted Health Information Exchange Organizations. We currently contract with MyHealth Access Network.

As a SoonerCare member, or as the members personal representative, you may opt out of having medical information shared by the HIE at your primary care providers office or at the hospital providing care.

To find out if your medical records are being shared within the HIE, please contact your medical provider. If your records are being shared within the HIE, and you wish to opt out, your medical provider will provide you with the appropriate standard form and instructions on how to submit the form, or you may obtain an opt out form directly from the HIE organization’s website.

To learn more about the HIE Organization, please visit their website at:

MyHealth Access Network:

Medicaid Expansion Ballot Measure: The Backstory

The process of getting a Medicaid expansion measure on the ballot and approved by voters took a substantial amount of work. Medicaid expansion supporters in Oklahoma gathered signatures in 2019 for Question 802, which called for Medicaid expansion under the terms outlined in the ACA . They needed 177,958 valid signatures by October 28, 2019, and reportedly submitted 313,000 the most signatures that had ever been collected for a ballot initiative in the state. In January 2020, Oklahomas Secretary of State confirmed that the measure would appear on the ballot in 2020.

However, it was up to Gov. Kevin Stitt a Republican who opposes Medicaid expansion and had expressed opposition to the ballot initiative to determine whether the Medicaid expansion question should be on the primary ballot in June, or on the general election ballot in November. Stitt ultimately determined that the measure would appear on the June 30, 2020, primary ballot. Its rare for a governor to opt to put a ballot initiative on the primary ballot, although former Gov. Mary Fallin did so with a medical marijuana initiative in 2018.

A month later, voters in Oklahoma approved ballot Question 802, paving the way for full Medicaid expansion to take effect in the state as of July 2021.

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Medicaid Managed Care Transition Overturned By Ok Supreme Court

SoonerCare was set to transition to a managed care system in October 2021, but the Oklahoma Supreme Court ruled in June 2021 that the program was invalid under Oklahoma law and implementation was suspended.

Some backstory on this: In 1995, Oklahoma contracted with private insurers in a capitated managed care program to serve Medicaid enrollees in the Tulsa, Oklahoma City, and Lawton areas. But by 2004, the state had pulled the plug on the managed care system after too many providers dropped out.

In 2015, in an effort to reign in Medicaid spending growth, lawmakers in Oklahoma began considering the possibility of reviving the managed care model for the states Medicaid enrollees. Some advocates for Medicaid patients were opposed to the possibility, noting that it would result in disabled, blind, and elderly residents needing to switch to new doctors and new treatment plans. But supporters of privatization noted that there had been many advances in Medicaid managed care programs in the last two decades.

As of 2018, according to Kaiser Family Foundation data, Oklahoma was one of only 12 states that didnt have any managed care organizations contracted with their Medicaid program.

Process Of Soonercare Sign In

To use the SoonerCare Login Portal, you must create an account, including a username and password, with which you will log into the system. Creating a new account on the Soonercare login portal is very simple. Follow the steps below to SoonerCare Sign In.

If you dont have a user account, but you do have your personal identification number , you can now create an account with your PIN. If you dont already have a user account or PIN, create a new account now. Please read the terms and conditions carefully, to apply for SoonerCare Benefits, you must select I Agree to complete the soonercare application.

• The first step in the SoonerCare Sign In is to tell them about everyone who lives in the house.
• Start with an adult if one lives in the house.
• He is the point of contact for the file.
• The contact person must be at least 15 years old. When finished, select Next to continue. If you need further assistance, call 987-7767.

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