Care Management FAQ

  1. Does SoonerCare pay for dental services?
  2. Can I receive home health care services while on SoonerCare?
  3. How many prescriptions does SoonerCare cover each month?
  4. Is there a limit on how many times I can see a doctor?
  5. What kind of co-payments do I have to make?
  6. Does SoonerCare pay for eye exams?
  7. Do I always have to get a referral from my PCP?
  8. Is everyone that is on Medicaid also on Managed Care?

Q. Does SoonerCare pay for dental services?

A. Adult coverage is limited to emergency extractions only and reconstructive dental surgery when medically necessary. Members under age 21 can get routine dental care. No referral is needed from your PCP/CM. You may self-refer to a contracted provider.

Q. Can I receive home health care services while on SoonerCare?

A. Adults may receive up to 36 visits per calendar year when a PCP determines there is a skilled need for these services. Members under the age of 21 may receive unlimited home health care services when a PCP determines there is a skilled need for these services.

Q. How many prescriptions does SoonerCare cover each month?

A. Adults are limited to 6 per month, 3 of which may be brand name. There is a co-payment. Members under the age of 21 have no limits or co-payments for medically necessary prescriptions.

back to top

Q. Is there a limit on how many times I can see a doctor?

A. Visits to a PCP/CM are unlimited. Visits to a specialist are limited for adults to 4 times per month. There is no limit for members under the age of 21.

back to top

Q. What kind of co-payments do I have to make?

A. You are expected to make the following co-payments for the following medical services:

  • Inpatient hospital services: $3 per day.
  • Outpatient hospital services: $3 per visit.
  • Specialty care: $1 per visit.
  • Home health care: $1 per visit.

Prescription drugs:

  • $1 per drug costing 29.99 or less
  • $2 per drug costing 30.00 or more.

No co-payments are needed for the following:

  • Services to pregnant women.
  • Family planning services.
  • Emergency services.
  • Services if you show that you cannot pay.

back to top

Q. Does SoonerCare pay for eye exams?

A. Vision services for adults are not covered except for the treatment of eye disease or eye injuries. For members under the age of 21 yearly exams and glasses are covered when provided by a contracted provider. No PCP referral is needed.

back to top

Q. Do I always have to get a referral from my PCP?

A. No referral is needed for the following:

  • Emergency care (for a true medical emergency).
  • Dental services for members under age 21.
  • Vision services for members under age 21.
  • Family planning services if under the age of 18.
  • Behavioral Health services.
  • OB-Pregnancy care.
  • Indian Health services.
  • Child abuse exams.

back to top

Q. Is everyone that is on Medicaid also on Managed Care?

A. Persons who are not on Managed Care are those who:

  • Are dually eligible for Medicare and Medicaid;
  • Are in State or Tribal custody.
  • Are in a private HMO;
  • Are served in a home and community based waiver program; or
  • Are institutionalized.

back to top