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Medicaid Program - Overview - Oklahoma

Medicaid (Title XIX of the Social Security Act) provides health care to low-income Americans, long-term care for the elderly, and health services to people with disabilities. In addition, Medicaid reimbursements fund hospitals that serve as cornerstones for networks of other health care providers, including primary care physicians, specialists, pharmacies, vision services, dental services and transportation, among others.

Medicaid is administered by the Oklahoma Health Care Authority (OHCA) and is funded from Federal, State of Oklahoma, and in some cases, local revenues.

The federal government establishes and monitors certain requirements concerning Medicaid funding, eligibility standards, and quality and scope of medical services. States have the flexibility to determine certain aspects of their own programs in the areas of eligibility, reimbursement rates, benefits, and service delivery.

In Oklahoma, the OHCA establishes Medicaid rates, specifies the scope of medical services, contracts with health care providers, and establishes eligibility criteria. The Oklahoma Department of Human Services (DHS) takes applications and determines who is eligible for Medicaid. For DHS State and County Office contact information, see: http://www.okdhs.org/okdhslocal/

The Centers for Medicare and Medicaid Services (CMS) (formerly the Health Care Financing Administration) allows states to request waivers specifically to "waive" certain federal requirements of the program. Waivers extend Medicaid coverage to additional low-income and uninsured people, allow for some state flexibility in the design of its managed care delivery system, and allows managed care models to vary based on available community resources, geographic location, and experience in managed care practices.

Oklahoma offers two, separately managed care delivery systems within its Medicaid program -- SoonerCare Plus and SoonerCare Choice. SoonerCare Choice provides transportation services through SoonerRide to allow people to get to the services they need, while the Health Maintenance Organizations (HMOs) are responsible for the transportation of clients enrolled in the SoonerCare Plus program.

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Medicaid Program - Overview - Oklahoma

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