Medicaid Expansion

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Overview

Oklahoma’s Medicaid program, SoonerCare, currently covers only children, pregnant women, elderly adults, and disabled individuals.

On June 30, 2020, the Oklahoma Medicaid Expansion Initiative, State Question 802, passed by a majority vote to expand Medicaid eligibility to adults ages 19-64 whose income is 138% (133% with a 5% disregard) of the federal poverty level or lower. This equates to an estimated annual income of $16,970 for an individual or $34,846 for a family of four.


When will Medicaid Expansion go into effect?
July 1, 2021


How does Medicaid Expansion happen?
OHCA has submitted a state plan amendment to the Centers for Medicare and Medicaid Services (CMS) to expand the lives we cover. Once the agency receives approval from CMS and secures funding, the agency will move forward with enrolling new members in the expansion population.


Can I apply now for Medicaid Expansion?
Not yet. Our application process will be open to the newly expanded population beginning July 1, 2021, and can be accessed by visiting www.mysoonercare.org.

 
What does Medicaid Expansion mean for existing SoonerCare members?
Benefits for existing SoonerCare members will not change because of Medicaid expansion. However, certain populations may be enrolled into a third-party managed care program. Please check back as more information will soon be available regarding this new program.


Medicaid Expansion Funding

Ninety percent of costs for expansion enrollees will be paid by the federal government.  

Maximizing federal funding allows the state the ability to:

  • Promote integrated care and improve health outcomes, explore reinstating an adult dental benefit in SoonerCare, with a focus on preventive dental services. 
  • Pursue substance use disorder and serious mental illness waivers to expand access to prevention and treatment services. 
  • Coordinate with jails and prisons to help former inmates apply for SoonerCare coverage upon release, helping them get access to important behavioral health services immediately, thus reducing the risk of recidivism. 
  • Help jails and prisons capture additional SoonerCare funding for hospitalizations and surgeries as allowed under federal Medicaid law.


 


Frequently Asked Questions

       

Why is expansion only available for individuals with income up to 133% FPL?

This is the income limit allowed for the adult expansion population under federal law. However, with applicable income disregards, the effective FPL is 138% FPL.


How much will the expansion population pay in monthly premiums and co-pays? Why?

 

There are no premiums for members in the newly expanded SoonerCare population.

However, non-pregnant adults will be charged copayments up to the 5% out-of-pocket cost sharing limit, unless exempted from cost sharing requirements.

 



Related Links

OHCA Policy Blog