About Us

The Oklahoma Health Care Authority (OHCA) administers two health programs for the state. The first is SoonerCare, Oklahoma's Medicaid program. SoonerCare works to improve the health of qualified Oklahomans by ensuring that medically necessary benefits and services are available. Qualifying Oklahomans include certain low-income children, seniors, the disabled, those being treated for breast or cervical cancer and those seeking family planning services. The second program OHCA operates is Insure Oklahoma, which assists qualifying adults and small business employees in obtaining health care coverage for themselves and their families.

Our Vision

Our vision is for Oklahomans to be healthy and to have access to quality health care services regardless of their ability to pay.

Our Mission Statement and Goals

Our mission is to responsibly purchase state and federally-funded health care in the most efficient and comprehensive manner possible; to analyze and recommend strategies for optimizing the accessibility and quality of health care; and, to cultivate relationships to improve the health outcomes of Oklahomans.

Goal #1 – Responsible Financing
Purchase cost-effective health care for members by maintaining appropriate rates that strengthen the state's health care infrastructure.

Goal #2 – Responsive Programs
Develop and offer medically necessary benefits and services that meet the healthcare needs of our members.
 
Goal #3 – Member Engagement
Inform and engage members about how their choices and behaviors affect their own health status and services.

Goal #4 – Satisfaction and Quality
Protect and improve member health and satisfaction with health care services, as well as ensuring quality.

Goal #5 – Effective Enrollment
Ensure that qualified individuals in Oklahoma receive health care coverage.
 
Goal #6 – Administrative Excellence
Promote efficiency and innovation in the administration of OHCA.

Goal #7 – Collaboration
Foster collaboration among public and private individuals and entities to build a responsive health care system for Oklahoma.

Our Values

  • Innovation
  • Integrity
  • Accountability
  • Engagement
  • Inclusiveness

SoonerCare Basics

  Approval Timeline

  Basic Benefits 

  Federal Medical Assistance Percentage (FMAP) 

  Insure Oklahoma

  SoonerCare Eligibility 

  SoonerCare Enrollment

  SoonerCare Provider Audits 

  SoonerCare Provider Enrollment

Strategic Plan

The Strategic Plan reports priorities identified by the OHCA’s board. This part of the report includes a comprehensive discussion of the current operating environment and any projected issues that may affect the SoonerCare (Oklahoma Medicaid) program such as, federal regulations, the uninsured, political climate and economic indicators. Updates of ongoing action plans are also presented. The Strategic Plan provides a road map for the agency’s forward motion.

The Service Efforts and Accomplishments (SEA) Performance Report is included with the Strategic Plan. It is constructed to report outcomes of OHCA’s efforts to achieve its mission, goals and objectives. Part of this process is defining standard performance measures indicating both quality and quantity; this has the benefit of also providing management expectations. The SEA report allows management to compare past, current and targeted performance measures to identify successes, challenges and opportunities. The report identifies how each measure is related to the agency’s goals and objectives, as well as relevant factors affecting outcomes.

Quality Improvement Plan

OHCA has determined that a comprehensive agency-wide Quality Improvement Plan will be helpful to guide our programs, in much the same way that the Agency Mission and Strategic Plan give focus to our work every day. Regulations governing utilization control are mandated for all state Medicaid programs. Other regulations require a written quality strategy for specific managed care delivery systems, but not for the SoonerCare Choice Patient-Centered Medical Home program. The agency’s many departments share common goals for clinical excellence in the services that members receive and are dedicated to excellence in performing the administration of the program. The agency has voluntarily developed a Quality Improvement Plan to highlight the structure of the agency’s approach to quality, provide information about quality initiatives and highlight performance measures that are reported. The document outlines the agency’s work in quality assessment and performance improvement.

Core Functions

The agency core function summary is a high-level, extremely simplified overview of each OHCA unit duties, responsibilities and contact information. The core function summary does not necessarily reflect all of the required or performed functions of each unit.