Oklahoma Medicaid Office

Oklahoma Medicaid office (OHCA)

OHCA — the Oklahoma Health Care Authority — runs SoonerCare from a single administrative office in Oklahoma City and triages every inbound call by audience rather than topic. Members and applicants get one helpline. Providers get a second. Insure Oklahoma — OHCA's premium-assistance program for working adults with employer coverage — gets a third. Each line uses different hours, and routing to the wrong line is the most common reason questions sit unanswered.

Three audience-specific phone lines

The OHCA building sits at 4345 N. Lincoln Boulevard in Oklahoma City — just north of the State Capitol — with visitor parking on the east side. OHCA does not run a network of walk-in field offices. Day-to-day in-person help lives at DHS County Offices linked from the OHCA Find a Provider tool, or at community partners certified to submit SoonerCare applications.

SoonerGuide and the online channel

OHCA recently added "SoonerGuide," an AI assistant on the Contact Us page that fields general SoonerCare questions; it sits in front of (not in place of) the helpline. The application portal is separate — apply.okhca.org for new applications and renewals.

Who qualifies for SoonerCare?

SoonerCare publishes its eligibility groups as a flat list on the "Apply for Benefits" page rather than a tier structure. Eight categories qualify if other citizenship and income tests are also met. The list looks long because Oklahoma carries a few narrowly targeted categories — Oklahoma Cares, SoonerPlan, and a former-foster-youth window — in addition to the standard Medicaid groups.

Who qualifies for SoonerCare

• Adults with children under 19 — the parents and caretaker-relatives category.
• Children under 19 and pregnant women — the largest category by enrollment.
• Adults age 19–64 not eligible for Medicare — Oklahoma's Medicaid Expansion population, added after voter approval in 2020.
• Individuals 65 and older — non-MAGI track with both income and resource tests.
• Individuals who are blind or who have disabilities — also non-MAGI.
• Women under 65 in need of breast or cervical cancer treatment — covered through the Oklahoma Cares program.
• SoonerPlan — limited-benefit coverage for men and women 19 and older whose only need is family planning services.
• Former foster youth who aged out at 18 in another state on or after January 1, 2023 — Oklahoma honors continued Medicaid eligibility for foster youth from other states under the federal rule that took effect that date.

What this page does not tell you

The OHCA eligibility page links out to a separate Income Guidelines page rather than publishing a chart inline. Resource (asset) tests apply to the 65+ and blind/disabled categories but not the MAGI categories (children, pregnant women, parents, expansion adults). Verify both your category and the current income test by working through the apply.okhca.org online screening or calling the SoonerCare helpline at 800-987-7767.

SoonerCare income standards

OHCA does not republish a current SoonerCare income chart in HTML on its consumer Apply page. The agency keeps a separate Income Guidelines subpage and refers applicants to the apply.okhca.org screening flow, which calculates a household's eligibility against the most recent federal poverty level (FPL) update. The percentage standards below are stable from year to year; the dollar amounts they translate into change each January.

SoonerCare standards by category

Where to confirm the current dollar figures

Run the screening at apply.okhca.org, or call the SoonerCare helpline at 800-987-7767 (Mon–Fri, 8 a.m.–5 p.m. Central) to ask about a category-specific budget. Insure Oklahoma — separate from SoonerCare — uses different income tests and is reached at 888-365-3742.

How to apply for SoonerCare

OHCA structures the SoonerCare application as a four-step path rather than a single form. Steps one through three are preparation; the actual submission happens at apply.okhca.org at step four. Most applicants spend more time on step three (gathering documents) than on the form itself.

The four-step OHCA flow

Help with the online portal

OHCA publishes an Online Application Guide PDF that mirrors the portal step by step, plus eight short how-to videos — one per portal screen, from "People and Contacts" through "Provider Selection." If you get stuck mid-application, the SoonerCare helpline at 800-987-7767 can pull up your saved application and walk you through the next page.

Federal decision deadlines

Federal rules give OHCA up to 45 days to decide a non-disability SoonerCare application and up to 90 days for applications based on disability. Coverage can be retroactive up to three months before the application month if the applicant had qualifying medical bills during that window and met the eligibility criteria at the time.

What SoonerCare covers

SoonerCare covers a long list of medical services with a few patterns worth knowing up front: adult dental is limited, dentures are covered only for adults residing in nursing facilities, and there are explicit child-only extras layered on top of the general benefit set. SoonerRide handles non-emergency medical transportation. Three separate programs — Oklahoma Cares, SoonerPlan, and the HCBS waivers (branded as "In-Home Care") — extend the core SoonerCare coverage for specific populations.

Core medical benefits for SoonerCare members

• Doctor visits, preventive services, podiatry, and clinic services (including renal dialysis)
• Inpatient and outpatient hospital care; ambulatory surgery center services
• Prescription drugs and insulin
• Lab work, X-rays, ultrasound, durable medical equipment, and diabetic supplies
• Pregnancy services including prenatal, delivery, postpartum, breastfeeding support, and pregnancy services
• Outpatient behavioral health and substance abuse services
• Chemotherapy and radiation therapy
• Federally Qualified Health Center (FQHC) and rural health clinic services
• Home health, hospice, and personal care
• Family planning services and supplies
• Tuberculosis services and prior-authorized transplants
• Non-emergency medical transportation through SoonerRide
• Adult dental — limited (no routine adult dental in general; dentures covered only for adults residing in nursing facilities)

Additional services for children under 19

• Hearing aids and immunizations
• Optometric and optical services, including eyeglasses
• Orthodontics (when medically necessary)
• Physical and occupational therapy
• Speech, hearing, and language disorder services
• Private duty nursing
• Incontinence supplies for certain children ages 4–20
• Inpatient psychiatric services in an Institution for Mental Disease (IMD) for children

Three programs that layer on top of SoonerCare

• Oklahoma Cares — Breast and Cervical Cancer Treatment Services for women under 65 who screened positive through a qualifying program.
• SoonerPlan — family planning services and supplies for men and women age 19 and older whose income is over the SoonerCare full-benefit limit but who qualify for family planning only.
• In-Home Care (HCBS Waivers) — Home and community-based services for people who would otherwise need nursing-facility, ICF/IID, or institutional care.

SoonerCare CHOICE and the asterisks on the benefit list

SoonerCare CHOICE is OHCA's primary-care case management track and historically does NOT cover nursing-facility services, inpatient psychiatric care in an IMD for adults 65+, or services in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID). Those services route through fee-for-service Medicaid instead. The downloadable Comparison Chart of SoonerCare Benefits and Copays (PDF on the benefits page, titled "expansion with Choice") spells out the differences track by track.

Medicare cost sharing for dual-eligibles

If you have both Medicare and SoonerCare, SoonerCare pays the deductibles and a portion of the co-insurance on Medicare-covered services. OHCA also pays the monthly Medicare Part B premium for SoonerCare members age 65 or older and for certain blind or disabled members. Other insurance — employer plans, retiree plans, supplemental insurance — bills first; SoonerCare bills last.

Other state Medicaid pages