Chapter 5: Health and Mental Health
Section 2: SoonerCare (Oklahoma Medicaid)
Oklahoma Health Care Authority
4545 N. Lincoln Blvd., Ste. 124
Oklahoma City,OK 73105
800-522-0310 Toll Free
Administers SoonerCare, Oklahoma's Medicaid Program.
Who to Call with Questions About SoonerCare (Medicaid):
SoonerCare Eligibility Questions
Call your OKDHS county office.
8 a.m.-5 p.m. Monday through Friday
Visually impaired and translation services available. General questions, enrollment information, benefits information for members.
SoonerCare members can call SoonerRide at 1-877-404-4500 or the Relay Service at 711 or 1-800-722-0353 (TDD).
SoonerCare members can call the OHCA Call Tree (Customer Service) at 1-800-522-0310, 405-522-7171 or 405-522-7179 (TDD) from 7:30 a.m.-5:30 p.m. Monday through Friday.
SoonerCare is Oklahoma's state-funded managed care program. It is administered by the Oklahoma Health Care Authority (OHCA) and offers varying health benefit packages. These include:
SoonerCare Choice, in which each member has a medical home that provides basic health care services. Members have a primary care provider who takes care of most of their medical needs or refers them for specialty care as needed. Members with complex medical needs have access to exceptional needs coordinators to help coordinate and access appropriate care.
SoonerCare Traditional, a comprehensive medical benefit plan that purchases benefits for members on a fee-for-service basis. SoonerCare Traditional covers members who are institutionalized, in state or tribal custody or enrolled under a Home and Community-Based Waiver.
SoonerCare Supplemental, a plan for people who are covered by Medicare. SoonerCare Supplemental pays the co-insurance and deductible and provides medical benefits that supplement services covered by Medicare.
The Opportunities for Living Life program offers extra benefits to certain members in the SoonerCare Traditional or Supplemental plans. Those benefits may include long-term care facility services, intermediate care facility services for the mentally retarded (ICFMR), in-home personal care and other home and community-based supportive services that would give SoonerCare members an alternative to entering a long-term care facility.
TEFRA (Tax Equity and Fiscal Responsibility Act of 1982) helps children with disabilities who would not otherwise qualify for SoonerCare. It extends benefits to home-based children who meet an institutional level of care. Financial qualifications for TEFRA consider only the child's income, so the parent's income does not create an obstacle to enrollment. For more information, contact the SoonerCare Helpline at (800) 987-7767, (405) 522-7171 in the Oklahoma City area or (405) 522-7179 for TDD/TTY.
Oklahoma Cares provides SoonerCare benefits to women under age 65 who need further diagnostics or treatment for breast or cervical abnormal findings, precancerous conditions or cancer. Oklahoma Cares members are covered under either the SoonerCare Choice or SoonerCare Traditional benefit package until they no longer require treatment or qualify financially. Women who are interested should ask if their health care provider is a certified screening provider. If not, they can find a screening provider in their area by contacting the Oklahoma State Department of Health at (866) 550-5585.
SoonerPlan offers limited benefits for family planning services. SoonerPlan provides lab tests and office visits, contraceptive products, pregnancy tests, tubal ligations and vasectomies to women and men age 18 or older who do not usually qualify for full benefits under SoonerCare. For more information, contact your local county health department (to find it, call (800) 426-2747); your local county Oklahoma Department of Human Services office (call (405) 521-2779 for help); the Oklahoma Health Care Authority, (800) 987-7767 or (800) 757-5979 (TDD); family planning providers; or family planning clinics.
The Oklahoma Employer/Employee Partnership for Insurance Coverage (O-EPIC) Employer Sponsored Insurance (ESI) program is for Oklahoma small business owners with 250 or fewer employees and workers earning up to 250 percent of the federal poverty level. The O-EPIC ESI program combines contributions from the employer and employee with state funds from the tobacco tax to buy health insurance on the private market. O-EPIC's Individual Plan allows people who can't access O-EPIC through their employer, including those who are self-employed or may be temporarily unemployed, to buy health insurance directly through the state. The premiums are based on a sliding scale depending on the person's income. For more information about O-EPIC or an application, call 1-888-365-3742, or visit the Web site at www.insureoklahoma.org.
SoonerCare programs and benefits change periodically. For the most up-to-date information, contact the SoonerCare Helpline at 800-987-7767 or 800-757-5979 (TTY). The helpline is open from 8 a.m.-5 p.m. Monday through Friday. Information also is available on the Internet at www.okhca.org.
To correct, update or add resource listings notify:
Oklahoma Department of Rehabilitation Services
Public Information Office | Dana Tallon | Oklahoma Disability Resource Guide Editor