Medicaid in Oklahoma: What it is and who it covers

Medicaid is a joint federal and state program that provides health coverage to low-income individuals, including children, pregnant women, seniors, and those with disabilities. In Oklahoma, the program is known as SoonerCare and is administered by the Oklahoma Health Care Authority. According to the Kaiser Family Foundation, Medicaid covers approximately 20% of Oklahoma’s population.

What is the difference between Medicare and Medicaid?

The key difference between Medicare and Medicaid is who they serve and how they are funded.

Medicare is a federal health insurance program primarily for people 65 and older, as well as some younger individuals with disabilities or certain medical conditions. It is the same across all states and is funded through payroll taxes, premiums, and federal funding.

Medicaid is a state and federal program that provides health coverage for low-income individuals, including children, pregnant women, seniors, and people with disabilities. Each state runs its own Medicaid program, meaning eligibility and benefits can vary. Medicaid is funded jointly by state and federal governments.

A person can qualify for both Medicare and Medicaid, known as being “dual eligible”, which provides extra financial assistance for medical costs.

Who Qualifies for Medicaid in Oklahoma?

To be eligible for SoonerCare, applicants must meet income requirements and fall into specific categories, including:

1. Adults with children under 19
2. Children under 19 and pregnant women
3. Adults aged 19-64 who are not eligible for Medicare
4. Individuals 65 and older
5. Individuals who are blind or have disabilities
6. Women under 65 needing breast or cervical cancer treatment
7. Men and women 19 and older with family planning needs (SoonerPlan)
8. Young adults who aged out of foster care in another state on or after January 1, 2023

What Services Does Medicaid Cover?

Medicaid coverage varies by state, but federal law requires states to provide certain mandatory benefits, including:

1. Inpatient and outpatient hospital services
2. Physician services
3. Nursing facility and home health services
4. Family planning services
5. Transportation to medical care
6. Early and periodic screening, diagnostic, and treatment services for children

Oklahoma also offers optional benefits under SoonerCare, such as:

1. Prescription drugs
2. Dental and vision care
3. Physical and occupational therapy
4. Hospice and personal care services

How Medicaid Impacts Oklahomans

For thousands of Oklahomans, SoonerCare provides access to essential medical services that might otherwise be unaffordable. The program helps reduce financial burdens on families, supports preventive care, and ensures that vulnerable populations receive necessary treatments. Additionally, Medicaid assists rural and underserved communities by funding healthcare providers and clinics across the state.

For more information on Medicaid in Oklahoma, visit Medicaid.gov or SoonerCare’s website.