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To apply for Medicaid, a Medical Assistance Application is signed by the individual, parent, spouse, guardian, or someone else acting on the individual's behalf. Application may be made in a variety of locations, for example, a physician's office, a hospital or other medical facility, or in the county DHS office. Certain providers may take applications and then forward them to the DHS county office for Medicaid eligibility determination. The physician or facility will forward the application to the county DHS office of the patient's residence for processing. For DHS State and County Office contact information, see:
http://www.okdhs.org/okdhslocal/
Form MS-MA-5, "Notification of Needed Medical Services", is required only for preauthorization of medical services. The form may be submitted by the physician or facility as notification for a need for medical service and may be accepted as medical verification of pregnancy.
Either receipt of the Medical Assistance Application form or Form MS-MA-5 constitutes an application for Medicaid.
If the applicant also wishes to apply for a State Supplemental Payment, either the applicant or his/her guardian must sign the Medical Assistance Application form.
The Oklahoma Medical Assistance Application form is available for download from the Department of Human Services website. You may also download the SoonerCare Health Benefits Application Form (SC-1) in PDF format (requires Adobe Acrobat Reader). Get the form at:
http://www.okhca.org/publications/pdflib/SCapplication_english.pdf
SoonerCare - Overview - Oklahoma
SoonerCare Plus - Overview - Oklahoma
SoonerCare Choice - Overview - Oklahoma
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