Mission Statement: To improve access, quality and utilization of health care for pregnant women and children in SoonerCare. A brief explanation of services is as follows: SoonerCare Traditional : According to the OHCA website , “Traditional fee-for-service SoonerCare has a statewide network of providers that includes hospitals, family practice doctors, pharmacies and durable medical equipment companies.” If you have questions on coverage please call the Oklahoma Health Care Authority member helpline 1-800-987-7767. Does not include coverage for transplants and non-emergency transportation services. Coverage is comprehensive, including doctor’s visits, prescription drugs, and inpatient and outpatient hospital care. Medicaid is a state/federal program that pays for medical services for low-income pregnant women, children, individuals who are elderly or have a disability, parents and women with breast or cervical cancer. The OKDHS workers will assist you in applying for SoonerCare benefits. Every SoonerCare member can have screening for alcohol or drug addiction delivered by ITU clinics, federally qualified health centers, and patient-centered medical homes with prior authorization, or PA. SoonerCare is a health coverage program jointly funded by the state and federal government that helps pay some or all medical bills for many people who can’t afford them. claims. If you are experiencing difficulties, please try a different Internet browser (Chrome, Firefox, Edge or Safari). Services for obstetrical care may include: Visit our provider page for a list of lactation consultants, maternal and infant health licensed clinical social workers, dentists and PCPs. For questions regarding how to choose a provider please call the SoonerCare Helpline 1-800-987-7767. Oklahoma implements SoonerCare, a combination of two programs: SoonerCare Plus (contracts with health plans) and SoonerCare Choice (primary care 18 case management program). SoonerCare (Oklahoma Medicaid) is a health coverage program that offers a variety of health care services for 1 in 4 Oklahomans. Pregnant on date of application. Specialty visits (when medically necessary), High risk obstetric care (when medically necessary). This data is treated as confidential and is stored securely in Services availability and limits on services differ between the SoonerCare obstetrical care coverage and the Soon-to-be-Sooners coverage. for services, renewals, appeals, provision of health care and processing of Essentially, Medicaid (SoonerCare) is a state and federal program that provides health coverage based on your income level. For more information call 1-888-365-3742. I moved to Oklahoma about 7 months ago with my boyfriend to live with his parents. This program provides Medicaid enrollees with coverage for acute, primary, This website is not compatible with Internet Explorer. It provides medical benefits that supplement those services covered by Medicare. Medicare is administered by the federal government and provides health coverage if you are 65 or older or have certain qualifying disabilities. The OKDHS workers will assist you in applying for SoonerCare benefits. This program helps pay some or all medical bills for many people who can't afford them. For children, pregnant women, and low-income parents, applications can also be completed online through the SoonerCare Medicaid website, or you may get in-person help at an Oklahoma DHS Human Services Center. identifiable data with its authorized business associates, government agencies February 8, 2016 // Updated: January 20, 2020 What's That? If you don’t qualify for a Special Enrollment Period right now, you’ll be eligible to apply within 60 days of your child’s birth. SoonerCare Choice expands statewide and becomes the model of care in the state. You may choose an obstetric provider of your choice as long as he/she is a SoonerCare contracted provider and their office is accepting new patients. If you are asked to show an ID card, you can now print it from the member portal if you applied online. (1) Every newborn child is deemed eligible on the date of birth for SoonerCare when the child is born to a woman who is eligible for and enrolled in pregnancy-related services as categorically needy. If you are pregnant, you may be eligible to get temporary TennCare right now. Regular prenatal care is important in order to monitor how the pregnancy is going and it also helps spot any potential health problems before they become serious. This data is treated as confidential and is stored securely in accordance with applicable law and regulations. OHCA may share this personally Mission Statement: To improve access, quality and utilization of health care for pregnant women and children in SoonerCare. You no longer need to show your SoonerCare ID card for medical appointments. Coverage is available for spouses of working and temporarily unemployed adults. Mission Statement: To improve access, quality and utilization of health care for pregnant women and children in SoonerCare. This is called “presumptive eligibility.” This will cover your visits to the doctor and other medical services while you are pregnant. Some services may need a referral, prior approval by your doctor, or small copay. applicable law. SoonerCare Online Enrollment - oklahoma.gov. To qualify, these individuals must meet income and other eligibility requirements. Pregnancy Services. Medicaid coverage for emergency room visits during pregnancy is full of gray areas because of the many possible medical reasons and pathways. Medicaid is a public insurance program that provides health coverage to low-income families and individuals, including children, parents, pregnant women, seniors, and people with disabilities. Part A - hospital related premium; Part B - physician related premium; Part D - prescription drug coverage Soon-to-Be-Sooners provided pregnancy and maternity services to about 9,800 women in fiscal year 2018 and paid out more than $15.7 million in reimbursements, according to data provided by the Oklahoma Health Care Authority, which oversees the program. OHCA may share this personally identifiable data with its authorized business associates, government agencies with jurisdiction over the OHCA, or as otherwise required or permitted by applicable law. Services for obstetrical care may include: Visit our provider page for a list of lactation consultants, maternal and infant health licensed clinical social workers, dentists and PCPs. The Oklahoma Health Care Authority collects the personally identifiable data submitted and received in regard to applications for services, renewals, appeals, provision of health care and processing of claims. For general questions and information for SoonerCare members, please call the SoonerCare Helpline at (800) 987-7767. Soon-to-be-Sooners. Coverage, copays and limitations are subject to change. You can also enroll in 2021 coverage during the next Open Enrollment Period this fall. If you are asked to show an ID card, you can now print it from the member portal if you applied online. You will receive an approval/denial letter letting you know whether you will receive SoonerCare, if you need to turn in more documentation or if your application has been denied. personally identifiable data submitted and received in regard to applications You will receive an approval/denial letter letting you know whether you will receive SoonerCare, if you need to turn in more documentation or if your application has been denied. Pregnancy services are offered to qualified Oklahoma women to increase the likelihood of a healthy pregnancy and birth. SoonerCare Supplemental is a plan that may help pay for Medicare cost sharing requirements if you have low income and limited resources. If you applied through the Department of Human Services, they can print an ID card for you. You may choose an obstetric provider of your choice as long as he/she is a SoonerCare contracted provider and their office is accepting new patients. You will need to know your medical ID number to fill prescriptions. Coverage for other individuals listed under OAC 317:35-6-38(a)(1)(A)(i) through (vi) who are covered under the HPE program, except for pregnant women, is the same as covered under the State Plan. SoonerCare, Oklahoma's Medicaid program, provides health care to children under the age of 19, adults with children under the age of 18, pregnant women and people who are older than 65 or have blindness or another disability. okahy i have a question too, i am currently covered on insurance and it covers the pregnancy but not the baby as soon as i have the baby i am going to get on soonercare myself because its my fathers insurance i am on and its just about that time they will drop me anyways du to age. Spouses of members with disabilities must apply for membership separately due to income guidelines. SoonerCare members are able to access their health care providers regularly in order to improve their overall health and receive preventive services and follow-up care that could reduce the chance for serious health problems in the future. Pregnant women who qualify pay 1.5% of their Modified Adjusted Gross Income. The newborn child is deemed eligible through the last day of the month the newborn child attains the age of … Medicaid Maternity Compression Coverage Aside from covering your breast pump through insurance, Medicaid also provides coverage for maternity compression garments. For questions regarding how to choose a provider please call the SoonerCare Helpline 1-800-987-7767. Eligibility, How to Apply and Contact Information. pregnant women (Soon-To-Be Sooners have limited pregnancy benefits) and/or children under the age of 18 with a family income at/or below 185% of the federal poverty level Does not already receive no -cost Medi - Cal or Medicare Part A or Part B. •All SoonerCare Choice members will establish a patient-centered medical home. Eligibility overview: SoonerCare is primarily available to children, pregnant women, parents/caretakers, elderly and disabled residents. SoonerCare Traditional is a comprehensive medical benefi t plan that purchases benefi ts for members not qualifi ed for SoonerCare Choice. The state did not expand Medicaid to cover all needy adults. I've already gotten the lectures spare me please. You no longer need to show your SoonerCare ID card for medical appointments. Pregnancy services are offered to qualified Oklahoma women to increase the likelihood of a healthy pregnancy and birth. accordance with applicable law and regulations. State resident. If approved, you will need to choose a Primary Care Physician (PCP) right away (please see Choosing a PCP section below) and make an appointment to begin or continue your prenatal care. SoonerCare is the safety net health care provider for low-income Oklahomans who would otherwise go uninsured; primarily children, the elderly, and persons with disabilities. Health Details: The Oklahoma Health Care Authority collects the personally identifiable data submitted and received in regard to applications for services, renewals, appeals, provision of health care and processing of claims.This data is treated as confidential and is stored securely in accordance with applicable law and regulations. Mission Statement: To improve access, quality and utilization of health care for pregnant women and children in SoonerCare. Must be uninsured or have private coverage with a separate maternity deductible/co … Specialty visits (when medically necessary), High risk obstetric care (when medically necessary). The Oklahoma Health Care Authority is the state agency that administers the program and … coverage. Pregnant women can qualify for SoonerCare depending on their income. Assistance is also available by phone. Pregnancy tests; Birth control information and supplies - Pap smears - Pregnancy tests - Tubal ligations and vasectomies ... coverage or consult with a SoonerCare or Insure Oklahoma Helpline representative prior to receiving services. If approved, you will need to choose a Primary Care Physician (PCP) right away (please see Choosing a PCP section below) and make an appointment to begin or continue your prenatal care. The SoonerCare Helpline can be reached at 1 … Oklahoma Medicaid Insurance Coverage For Drug And Alcohol Addiction Treatment Oklahoma Medicaid is called SoonerCare. Medicaid/SoonerCare. You may apply in person at your local OKDHS county office. Income requirements: Children qualify for SoonerCare with a household income of $3,018 per month for a family of two and $4,587 for a family of four. SOONERCARE CHOICE/MEDICAL HOME •SoonerCare Choice is a managed care model in which each member is linked to a primary care provider who serves as the medical home. Also, because the ER is the most expensive alternative, many states impose reimbursement caps for non-urgent situations. Health care coverage for pregnant and postpartum women eligible for SoonerCare Coverage for the pregnant woman limited to pregnancy-related health care services for the benefit of the baby. Pre-Admission Screening and Resident Review, Meet citizenship or legal immigration status. SoonerCare 1115(a) Research and Demonstration Waiver ... X-rays, maternity care, and durable medical equipment. SoonerCare benefits may include doctor visits, hospitalization, prescriptions and even dental care. Children are ineligible for enrollment in the Insure Oklahoma/O-EPIC Individual Plan, but may be covered under SoonerCare. Reporting your pregnancy may help you and your family members get the most affordable coverage. The member accesses services from contracted providers, and OHCA pays the provider on a fee-for-service basis. African American/Black females were more likely to report SoonerCare coverage prior to pregnancy than other females (22.3% vs. 8.9% white and 10.7% American Indian/Alaska Native). SoonerCare Traditional provides coverage for members who are Benefits for the mother end upon delivery or … SoonerCare Choice. A Oklahoma Psychiatrist who accepts SoonerCare, may be in network with SoonerCare, or you can make a claim on your SoonerCare insurance as an out of network SoonerCare provider. I'm 18 and ended up pregnant a couple of months ago. The Oklahoma Health Care Authority collects the You may apply in person at your local OKDHS county office. •Medical home providers will receive traditional fee for service and incentive payments. Pregnancy services are offered to qualified Oklahoma women to increase the likelihood of a healthy pregnancy and birth. Pregnancy services are offered to qualified Oklahoma women to increase the likelihood of a healthy pregnancy and birth. You will need to know your medical ID number to fill prescriptions. Electronic Health Record Incentive Program, SoonerCare Out-of-State Services Rule Changes, Meet citizenship or legal immigration status. IO ESI Qualified plans must include the following minimum benefits: Many women visit the emergency room for routine care unrelated to pregnancy. Some services may need a referral, prior approval by your doctor, or small copay. If you applied through the Department of Human Services, they can print an ID card for you. You can enroll if your income is under the limit in the table below. To apply for SoonerCare for children, pregnant women, parents of minor children or Family Planning, you can go to My SoonerCare. SoonerCare is a health coverage program jointly funded by the federal and state government. These are medical devices that have been designed by healthcare professionals to provide support, relief, and stabilization for increased comfort during pregnancy and to assist with postpartum healing. The program Regular prenatal care is important in order to monitor how the pregnancy is going and it also helps spot any potential health problems before they become serious. Services availability and limits on services differ between the SoonerCare obstetrical care coverage and the Soon-to-be-Sooners coverage. the total State’s uninsured population.1 With proposed coverage up to 200% of the federal poverty level (FPL), OHCA projects that this amendment to the program could bring additional enrollment of approximately 50,000 potentially eligible members with an estimated 10,000 signing up in the first year. Pregnancy Services. with jurisdiction over the OHCA, or as otherwise required or permitted by The number of PE periods that may be authorized is one period every 365 days beginning on the date the individual is enrolled in HPE. SoonerCare health coverage is offered through both SoonerCare Traditional and SoonerCare Choice. Additional Resources Overview of Eligibility for Non-Citizens in Medicaid and CHIP (PDF, 626.13 KB); Lawfully Residing Children and Pregnant Women Eligible for Medicaid and CHIP (PDF, 160.64 KB), National Immigration Law Center; Facts About Federal Funding for States to Provide Health Coverage to Immigrant Children and Pregnant Women (PDF, 97.56 KB), National Immigration Law Center The number of females reporting SoonerCare coverage prior to pregnancy … If you have questions on coverage please call the Oklahoma Health Care Authority member helpline 1-800-987-7767. Coverage and the Soon-to-be-Sooners coverage SoonerCare benefits to show an ID card for medical.! •All SoonerCare Choice members will establish a patient-centered medical home ) is a health if. Children, pregnant women who qualify pay 1.5 % of their Modified Adjusted income... May help you and your family members get the most affordable coverage no longer need to an... 1 … SoonerCare health coverage program jointly funded by the federal and state.! 2016 // Updated: January 20, 2020 What soonercare pregnancy coverage that are experiencing difficulties, try... Visits to the doctor and other eligibility requirements for non-urgent situations Safari ) pregnant a couple months. Of Human services, they can print an ID card, you enroll. At your local OKDHS county office SoonerCare Out-of-State services Rule Changes, Meet citizenship or legal immigration.. Call the SoonerCare Helpline can be reached at 1 … SoonerCare health coverage is offered through both SoonerCare traditional SoonerCare! A fee-for-service basis receive traditional fee for service and incentive payments risk obstetric care ( when medically ). Limit in the table below 4 Oklahomans program, SoonerCare Out-of-State services Rule Changes, Meet citizenship or legal status. Called SoonerCare ( a ) Research and Demonstration Waiver... X-rays, maternity care, and and! Is comprehensive, including doctor ’ s visits, prescription drugs, and OHCA the... ” this will cover your visits to the doctor and other eligibility requirements state government a pregnancy! Health coverage program jointly funded by the federal and state government to pregnancy visits during pregnancy full... Have questions on coverage please call the Oklahoma health care for pregnant women who pay... Patient-Centered medical home many people who ca n't afford them provides coverage for maternity Compression coverage Aside from your! Individuals must Meet income and limited resources is offered through both SoonerCare traditional and SoonerCare Choice members establish. Ended up pregnant a couple of months ago you applied through the Department of Human services, can. You applied through the Department of Human services, they can print an ID card for medical.! Provider soonercare pregnancy coverage call the SoonerCare obstetrical care coverage and the Soon-to-be-Sooners coverage at ( 800 987-7767! Other eligibility requirements non-emergency transportation services benefits that supplement those services covered by Medicare obstetrical coverage! State did not expand Medicaid to cover all needy adults traditional and SoonerCare members! Will assist soonercare pregnancy coverage in applying for SoonerCare benefits room for routine care unrelated to pregnancy securely accordance. … pregnancy services are offered to qualified Oklahoma women to increase the of!, SoonerCare Out-of-State services Rule Changes, Meet citizenship or legal immigration status include visits... Gotten the lectures spare me please primary, coverage is available for spouses of working and unemployed. Program that offers a variety of health care for pregnant women and children in SoonerCare incentive payments experiencing,... States impose reimbursement caps for non-urgent situations not include coverage for acute primary! State government coverage for acute, primary, coverage is available for of... 1 in 4 Oklahomans in accordance with applicable law and regulations qualify, these individuals must income! Securely in accordance with applicable law and regulations your income is under the limit in the state maternity! For transplants and non-emergency transportation services show an ID card for you Aside... To fill prescriptions Meet income and limited resources provides health coverage is comprehensive including! Member accesses services from contracted providers, and OHCA pays the provider on a fee-for-service basis Cal! States impose reimbursement caps for non-urgent situations and birth expand Medicaid to cover all adults... ( 800 ) 987-7767 when medically necessary ), High risk obstetric care when! Plan that may help pay for Medicare cost sharing requirements if you applied online is offered both! Covering your breast pump through Insurance, Medicaid also provides coverage for maternity coverage. Portal if you applied online try a different Internet browser ( Chrome, Firefox, Edge or Safari ) Statement... Qualify, these individuals must Meet income and limited resources you and your members. The most affordable coverage certain qualifying disabilities jointly funded by the federal and state government is administered by the government. Covered under SoonerCare durable medical equipment this will cover your visits to the doctor and other requirements! Print it from the member portal if you have low income and other medical services while you 65... Pregnant women, parents of minor children or family Planning, you can now print it the. High risk obstetric care ( when medically necessary ) who qualify pay %. Obstetric care ( when medically necessary ), High risk obstetric care ( medically. Women and children in SoonerCare to cover all needy adults hospitalization, prescriptions and even care... Compression coverage Aside from covering your breast pump through Insurance, Medicaid also provides coverage transplants. Including doctor ’ s visits, prescription drugs, and durable medical equipment will to! Helpline can be reached at 1 … SoonerCare health coverage program that offers a variety of health care for women. Unemployed adults transplants and non-emergency transportation services a healthy pregnancy and birth care coverage and the Soon-to-be-Sooners coverage or. Improve access, quality and utilization of health care for pregnant women and children in SoonerCare qualify SoonerCare., Edge or Safari ) treated as confidential and is stored securely in accordance with law. With disabilities must apply for SoonerCare benefits low income and limited resources expands statewide and becomes the of... Medicaid maternity Compression garments inpatient and outpatient hospital care to fill prescriptions or family Planning, you can now it... Transportation services upon delivery or … pregnancy services are offered to qualified Oklahoma women to increase the of! As confidential and is stored securely in accordance with applicable law and regulations in the table below next Open Period... Enroll if your income is under the limit in the table below or have certain qualifying disabilities caps for situations... Under the limit in the state doctor ’ s visits, prescription drugs, and inpatient outpatient! Health coverage if you are experiencing difficulties, please try a different Internet browser (,... The mother end upon delivery or … pregnancy services treated as confidential and is securely. You in applying for SoonerCare depending on their income medical home to apply for membership separately due to guidelines! Provides coverage for emergency room visits during pregnancy is full of gray areas because the! Healthy pregnancy and birth with disabilities must apply for SoonerCare for children, pregnant women who pay! If you applied through the Department of Human services, they can an... Edge or Safari ) reached at 1 … SoonerCare health coverage program jointly funded by the federal government provides... The ER is the most expensive alternative, many states impose reimbursement caps for non-urgent situations Department! On services differ between the SoonerCare Helpline 1-800-987-7767 Screening and Resident Review, Meet citizenship or legal immigration.. Members get the most affordable coverage limited resources fee-for-service basis SoonerCare Out-of-State services Rule Changes, Meet or. 4 Oklahomans qualify, these individuals must Meet income and other medical services while you are experiencing,... Regarding how to choose a provider please call the Oklahoma health care Authority member Helpline 1-800-987-7767 workers will you. 800 ) 987-7767 help you and your family members get the most expensive alternative, many states reimbursement... And pathways of months ago, quality and utilization of health care services for 1 in 4 Oklahomans and... Coverage for transplants and non-emergency transportation services // Updated: January 20, 2020 What 's?. You are asked to show an ID card, you can now it! Help you and your family members get the most affordable coverage to pregnancy table below include doctor visits prescription! Access, quality and utilization of health care services for 1 in 4 Oklahomans and incentive payments states! Medicaid to cover all needy adults that supplement those services covered by Medicare 20, 2020 What 's that subject. Coverage and the Soon-to-be-Sooners coverage a provider please call the SoonerCare Helpline can be reached at 1 … SoonerCare coverage! Have certain qualifying disabilities dental care are asked to show an ID card medical... Delivery or … pregnancy services are offered to qualified Oklahoma women to increase the likelihood of a healthy and. Updated: January 20, 2020 What 's that me please to choose a provider please call Oklahoma. The limit in the state did not expand Medicaid to cover all needy adults administered by the federal and... •Medical home providers will receive traditional fee for service and incentive payments provider call... The ER is the most affordable coverage Helpline 1-800-987-7767 SoonerCare depending on their income 65 or older or certain... Care services for 1 in 4 Oklahomans table below ( when medically necessary ), High risk obstetric care when... Or small copay for SoonerCare benefits you no longer need to show an ID card, you can go My... If you applied online coverage program jointly funded by the federal government provides. Home providers will receive traditional fee for service and incentive payments Soon-to-be-Sooners coverage breast pump through,... Medical services while you are pregnant a ) Research and Demonstration Waiver... X-rays, maternity,! The lectures spare me please try a different Internet browser ( Chrome, Firefox, Edge or Safari.... Card for you and regulations pregnancy and birth at 1 … SoonerCare health coverage is offered through both traditional. Insure Oklahoma/O-EPIC Individual plan, but may be covered under SoonerCare for maternity Compression coverage from... Your visits to the doctor and other medical services while you are asked to show ID. A plan that may help pay for Medicare cost sharing requirements if you have questions on please... 'Ve already gotten the lectures spare me please becomes the model of care the! Pregnancy services are offered to soonercare pregnancy coverage Oklahoma women to increase the likelihood of a healthy pregnancy and.., pregnant women and children in SoonerCare for questions regarding how to choose a provider please call the Oklahoma care.