Alyssa Lane
Medicaid is a federal health insurance program for people with low incomes. Each state has its own eligibility requirements and programs. In Oklahoma, Medicaid is called SoonerCare, and it covers a variety of medical and dental plans. As of early 2023, more than 330,000 people have gained health insurance coverage through SoonerCare.
| Characteristics | Values |
|---|---|
| Name of the program in Oklahoma | SoonerCare |
| Who does the program cater to? | Low-income individuals of all ages |
| Who administers the program? | Oklahoma Department of Human Services (OKDHS) |
| Who funds the program? | The state and the federal government |
| How many people have gained coverage since the expansion in July 2021? | More than 330,000 |
| What are the categories of long-term care programs? | 1. Institutional/Nursing Home Medicaid 2. SoonerSelect Medicaid managed care program |
| How to apply? | HealthCare.gov, phone, or through the SoonerCare enrollment portal |
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What You'll Learn
Who is eligible for Medicaid in Oklahoma?
Medicaid in Oklahoma is called SoonerCare, and it provides health care to several groups of people. Firstly, children under the age of 19 are eligible for SoonerCare. Secondly, adults with children under the age of 18 may be eligible, depending on their income. Thirdly, pregnant women can be eligible for SoonerCare, and this extends to post-partum women for up to 60 days after giving birth. Additionally, people who are older than 65 or have blindness or another disability can receive SoonerCare.
There are several other programs that are part of SoonerCare. These include Aged, Blind and Disabled; Family Planning; Health Care for Children with Disabilities (TEFRA); and Health Screening, Diagnosis and Treatment (EPSDT). Recipients of the Temporary Assistance to Needy Families (TANF) program are automatically eligible for health benefits under SoonerCare. Adults with children under the age of 18 who do not receive TANF may, in some circumstances, also be eligible for medical services under SoonerCare.
In addition to SoonerCare Medicaid, the state of Oklahoma also operates SoonerPlan. This is a state-funded program that provides family planning services to men and women with incomes that do not exceed 133% of the poverty level and who are not enrolled in SoonerCare Medicaid. Another state-run program, Insure Oklahoma, subsidizes private health insurance for residents with incomes up to the poverty level. Prior to 2014, the upper-income limit for Insure Oklahoma was 200% of the poverty level, but this was lowered in January 2014.
To be eligible for medical benefits in Oklahoma, a person will need to apply for and receive a disability determination from the Social Security Administration. To be considered disabled, a person must have a physical or mental impairment, disease, or loss that appears reasonably certain to continue for at least 12 months without significant improvement and that substantially impairs their ability to work or engage in useful occupations.
Oklahoma is an income-cap state, meaning that Medicaid long-term care applicants must meet a hard income limit. Single applicants' income must not exceed $3,021 per month to qualify for full Medicaid coverage, while couples applying together may have higher income limits. There is also a limit on assets, with single applicants allowed up to $2,000 in countable assets and married applicants allowed up to $3,000. Certain assets are exempt, including personal belongings, household furnishings, an automobile, and irrevocable burial contracts up to $10,000. Additionally, one's primary home is generally exempt.
Oklahoma has a Medicaid Look-Back Period of 60 months, during which it checks to ensure that no assets were sold or given away under fair market value. Violating this rule results in a Penalty Period of Medicaid ineligibility.
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How has Oklahoma's Medicaid enrollment grown?
Oklahoma's Medicaid program, SoonerCare, has seen significant growth in enrollment over the years, especially with the expansion of Medicaid in the state. As of early 2023, Oklahoma's Medicaid expansion covered more than 330,000 people, a substantial increase since its implementation.
The growth in enrollment can be attributed to several factors. Firstly, Oklahoma expanded its Medicaid program, which increased coverage for non-elderly adults earning up to 138% of the poverty level. This expansion alone brought coverage to over 330,000 people. Additionally, the state operates SoonerPlan, which provides family planning services to individuals with incomes up to 133% of the poverty level who are not enrolled in SoonerCare.
Another contributing factor is the Insure Oklahoma program, which predates the Affordable Care Act (ACA) and subsidizes private health insurance for residents with incomes up to the poverty level. Prior to 2014, the upper-income limit for Insure Oklahoma was higher, at 200% of the poverty level. The state's enrollment growth is also influenced by eligibility criteria, which include income and asset limits. For example, in 2025, a single Nursing Home Medicaid applicant in Oklahoma must meet specific criteria related to income, assets, and care needs.
The COVID-19 pandemic also played a role in the growth of Medicaid enrollment in Oklahoma. The economic fallout from the pandemic led to significant increases in enrollment as more people sought healthcare coverage during that time. Additionally, the continuous enrollment provision, which was in place until March 2024, contributed to sustaining and growing enrollment numbers.
While there was a decline in Medicaid enrollment growth in FY 2024, Oklahoma still experienced a notable increase in ACA enrollment from 2020 to 2024, with a growth rate of 227%, second only to Missouri's 243% growth rate. This growth in ACA enrollment, which includes Marketplace, Medicaid expansion, and BHP, reflects the changing healthcare needs and priorities of Oklahomans.
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What is the process to apply for Medicaid in Oklahoma?
As of early 2023, Oklahoma's Medicaid expansion covered more than 330,000 people. The program is called SoonerCare, and it was expanded as called for in the ACA as of July 2021.
How to Apply for Medicaid in Oklahoma
To apply for Medicaid in Oklahoma, you must meet the citizenship and income guidelines. You can apply for SoonerCare online or by mail. If you need help filling out the form, call the SoonerCare Helpline at 1-800-987-7767. You can also get in-person help at an Oklahoma DHS Human Services Center.
The application process involves providing personally identifiable data, which is treated as confidential and stored securely. You will need to provide information such as your income, assets, family size, and, if available, recent medical information.
If you are a single Nursing Home Medicaid applicant, you must meet the following criteria:
- Income under $2,901 per month
- Assets under $2,000
- Require a Nursing Home Level of Care
It is important to note that not meeting all of the above criteria does not mean you cannot become eligible for Medicaid in Oklahoma. You may take the Medicaid Eligibility Test to determine your eligibility.
Additionally, Oklahoma operates the Insure Oklahoma program, which subsidizes private health insurance for residents with incomes up to the poverty level. This program is separate from SoonerCare Medicaid and offers assistance to those with employer-sponsored insurance from enrolled employers.
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What are the income and asset limits for Medicaid in Oklahoma?
As of early 2023, Oklahoma's Medicaid expansion covered more than 330,000 people. The state-run Medicaid program in Oklahoma is called SoonerCare.
Income Limits for Medicaid in Oklahoma
Medicaid in Oklahoma is available to low-income individuals of all ages. The income limits vary depending on the applicant's age, disability status, marital status, and number of dependents. Here are the general income limits for different categories of applicants:
- Adults age 65 and older: In 2025, a single nursing home Medicaid applicant in Oklahoma must have an income under $2,901 per month. For couples applying together, the income limit may be higher, and there is a higher limit for veterans.
- Adults with disabilities: In 2021, adults with disabilities could qualify for Medicaid in Oklahoma if their income was up to 138% of the poverty level.
- Parents: Parents with income up to 42% of the poverty level may be eligible.
- Pregnant women: Pregnant women with income up to 138% of the poverty level may qualify for Medicaid.
- Children under age 19: Children under age 19 with income up to 205% of the poverty level may be eligible for Medicaid.
Asset Limits for Medicaid in Oklahoma
In addition to income limits, there are also asset limits for Medicaid eligibility in Oklahoma. As of 2021, an individual could only have assets in their name that did not exceed $2,000. However, certain assets are exempt from this limitation, such as personal belongings, household furnishings, one motor vehicle, wedding and engagement rings, and heirloom jewellery. The primary home is generally exempt from the asset limit, but it may be subject to Medicaid's Estate Recovery Program after the beneficiary's death.
For couples, all assets are considered jointly owned, and the community spouse (the non-applicant spouse) can retain a certain maximum amount, known as the Community Spouse Resource Allowance (CSRA). In 2021, the CSRA allowance was $130,308, with a minimum allowance of $26,076. In 2025, the community spouse can retain up to 50% of the couple's combined assets, with a maximum of $157,920.
It's important to note that Oklahoma has a Medicaid Look-Back Period of 60 months, during which it checks for any assets that were sold or given away under fair market value. This includes gifts or transfers made by a non-applicant spouse.
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What are the different programs under Oklahoma's Medicaid?
In Oklahoma, Medicaid is called SoonerCare. It is jointly funded by the state and federal governments and administered by the state under federally set parameters. The Oklahoma Department of Human Services (OKDHS) is the administering agency.
SoonerCare Medicaid covers medical expenses for certain groups of people with limited income and resources. This includes adults over 65, people with disabilities, pregnant women, parents, and children under 19. Eligibility depends on both income and assets. For example, in 2025, a single Nursing Home Medicaid applicant must have an income of under $2,901 per month and assets of under $2,000.
In addition to SoonerCare Medicaid, the state also operates SoonerPlan, a state-funded program that provides family planning services to men and women with incomes that do not exceed 133% of the poverty level and who are not enrolled in SoonerCare Medicaid. Another state-run program is Insure Oklahoma, which subsidizes private health insurance for residents with incomes up to the poverty level.
Oklahoma's Medicaid also includes the Children's Health Insurance Program (CHIP), which covers medical and dental care for uninsured children and teens up to age 19.
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Frequently asked questions
As of early 2023, more than 330,000 people have gained insurance due to the expansion of Medicaid in Oklahoma.
The Medicaid program in Oklahoma is called SoonerCare.
SoonerCare provides free or low-cost medical benefits to eligible low-income individuals of all ages. It also covers children under the Children's Health Insurance Program (CHIP).
Eligibility criteria for SoonerCare in Oklahoma vary based on age, income, and assets. For instance, adults 65 and older, and people with disabilities must meet certain income and asset requirements.
