What Oklahomans need to know about Medicaid

Even with the passage of State Question 802, many people do not fully understand the Medicaid system. I have focused this column on the information Oklahomans need to help those who might qualify or want further information.

The Oklahoma Health Care Authority (OHCA) is the state agency that administers Medicaid in Oklahoma. They are responsible for overseeing all aspects of who qualifies and who receives the benefit of insurance coverage through this program. The state Medicaid program is called SoonerCare. This provides health coverage that is jointly funded by the federal and state governments. This program helps pay some or all medical bills for many people who qualify under state law.

To qualify for SoonerCare, a person must reside in Oklahoma and be a U.S. citizen or fall into a qualified status. Most immigrants who arrived after August 22, 1996, cannot qualify for the program for five years. The most crucial criterion for SoonerCare is that clients must meet financial income and resource standards.

The following Oklahomans can apply and receive this assistance: adults with children under 19; children under 19; pregnant women; individuals 65 and older; individuals who are blind or who have disabilities; women under 65 in need of breast or cervical cancer treatment; and with SoonerPlan - men and women 19 and older with family planning needs.

As of May 2020, there were 833,302 Oklahomans enrolled in SoonerCare. In February, there were only 785,366 Oklahomans enrolled in SoonerCare. The increased enrollment is due primarily to COVID-19 economic impact. Of those currently enrolled, 551,778 were children (66%), and 281,524 were adults who qualified under various conditions (34%), or roughly two-thirds of SoonerCare enrollees being children.

Under the financial provisions, the current Federal Poverty Level (FPL) household income limits are: for a single person, the annual income must be at or under $16,971; for two persons, the annual income is $22,930; for three persons, the annual income is $28,888; and or a family of four, the annual income falls at $34,846.

These levels will increase in 2021 under the new constitutional amendment to the following estimated levels under 138% of the FPL: Individual - $17,236; Family of two - $23,335; Family of three - $29,435; and Family of four - $35,535. Surprisingly, an estimated 59% of currently uninsured Oklahomans will fall into these new income levels and qualify for SoonerCare.

Children have an elevated household FPL level of up to 210% due to coverage by the State Children’s Health Insurance Program (SCHIP). Even with those elevated rates, an estimated 83,000 Oklahoma children are currently without insurance coverage.

Just like other health insurance, there health care services that are covered. Coverage may include doctor visits, hospitalizations, and prescriptions. However, some limitations apply to ensure that only medically necessary services are provided. There is no cost for those who meet the income guidelines; however, co-pays may apply to some services.

People may ask about Medicare, and some confuse the two programs. Medicare is a federal health insurance program providing coverage mostly to individuals age 65 or older and some people with disabilities. If you are on Medicare and you qualify for Medicaid, SoonerCare pays only the deductibles and a portion of the co-insurance when procedures are covered by Medicare. To apply for Medicare benefits, visit or call your local Social Security Office.

To learn more, go to www.okhca.org to see if you or your children qualify for this benefit if you currently do not have health insurance.

Column provided by the Oklahoma Institute for Child Advocacy, which was established in 1983 by a group of citizens seeking to create a strong advocacy network that would provide a voice for the needs of children and youth in Oklahoma, particularly those in the state’s care and those growing up amid poverty, violence, abuse and neglect, disparities, or other situations that put their lives and future at risk. 

The Gayly. 7/6/2020 @ 3:47 a.m. CST.