Alyssa Lane
Medicaid is a state-federal program that provides free or low-cost medical benefits to low-income individuals and families. Each state has its own eligibility requirements and insurance plans available under Medicaid. Oklahoma's Medicaid program, known as SoonerCare, covers various groups, including low-income pregnant women, children, the elderly, and individuals with disabilities. The state has expanded its Medicaid program to include private insurers, and the SoonerSelect managed care program is expected to be implemented by spring 2024. This program will offer enrollees a range of medical and dental plans. Additionally, Oklahoma has specific eligibility criteria for long-term care Medicaid and allows for the transfer of income between spouses.
| Characteristics | Values |
|---|---|
| Who is eligible for Medicaid in Oklahoma | Low-income individuals of all ages, including the elderly, blind, disabled, pregnant women, parents, women with breast or cervical cancer, and children |
| Income eligibility | Income up to 42% of poverty for parents, income up to 138% of poverty level for pregnant women, and income up to 205% of poverty for children under age 19 |
| Insurance coverage | Nursing Home Medicaid, Medicaid Waivers/Home and Community-Based Services (HCBS), Children's Health Insurance Program (CHIP), Medicare Advantage Prescription Drug plans (MAPD), Dual Eligible Special Needs Plans (DSNP), Prescription Drug Plans (PDP) |
| Application process | Fill out an application with the Health Insurance Marketplace, information about current insurance plans may be required |
| Additional notes | Oklahoma's Medicaid program is called SoonerCare, and the managed care program is called SoonerSelect |
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What You'll Learn
Long-term care for seniors
In Oklahoma, Medicaid is called SoonerCare. This program provides long-term care for seniors in nursing homes, beneficiaries' homes, assisted living residences, and other settings through three programs: Nursing Home Medicaid, HCBS Waivers, and ABD Medicaid. These programs are different from regular Medicaid, which is available to people of all ages with financial limitations.
Nursing Home Medicaid
This program provides benefits for seniors in nursing homes. It is an entitlement, meaning that anyone who is eligible will receive assistance. In 2025, a single Nursing Home Medicaid applicant in Oklahoma must meet the following criteria:
- Income under $2,901 per month
- Assets under $2,000
- Require a Nursing Home Level of Care
HCBS Waivers
HCBS Waivers provide long-term care services and support to help financially limited seniors who require a Nursing Facility Level of Care but wish to remain in or return to living in the community instead of a nursing home. This includes care in beneficiaries' homes, adult day care, or assisted living. It is not an entitlement, and there are a limited number of participants due to enrollment caps. Therefore, waiting lists may exist. HCBS Waivers will not pay for room and board costs such as mortgage payments, rent, facility fees, utility bills, and food expenses. However, they will help cover basic healthcare expenses, such as primary care visits, prescription medication, and short-term hospital stays.
ABD Medicaid
ABD Medicaid is an entitlement program that provides various long-term care services, such as personal care assistance or adult day care.
Other Options
The Money Follows the Person (MFP) program assists Nursing Home Medicaid beneficiaries who want to leave their nursing home and transition back into the community. This help can include paying for moving expenses and long-term care in the new residence. Additionally, Oklahoma offers the following waivers for eligible individuals:
- My Life My Choice Waiver: Supports adults with physical disabilities transitioning to community-based living under the Living Choice program.
- ADvantage Program: Serves frail elderly individuals (65 or older) and adults (21 or older) with physical disabilities requiring nursing facility-level care.
- Medically Fragile Waiver: Provides services for individuals who meet hospital or skilled nursing facility-level care requirements.
- Sooner Seniors Waiver: Designed for adults 65 and older transitioning to community-based services through the Living Choice program.
- The Oklahoma Long-Term Care Partnership Program: Allows policyholders to protect assets dollar-for-dollar based on the policy's maximum benefit payout.
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Eligibility criteria for single nursing home applicants
Medicaid is a state/federal program that pays for medical services for low-income individuals of all ages. In Oklahoma, it is known as SoonerCare. To be eligible for SoonerCare, a person must meet certain financial and functional (medical) requirements. These requirements vary by the applicant's marital status, their spouse's application status, and the program they are applying for.
For single applicants seeking nursing home coverage through SoonerCare, there are specific eligibility criteria to meet. Firstly, there is an income limit of $2,901 per month in 2025. Secondly, the applicant's assets must not exceed $2,000. This includes cash, stocks, bonds, investments, bank accounts, and second homes. However, certain assets are exempt, such as personal belongings, household furnishings, an automobile, and irrevocable burial contracts up to $10,000. Additionally, their primary home is generally exempt from the asset limit, but it may be subject to Medicaid's Estate Recovery Program after their death.
Single applicants must also require a Nursing Home Level of Care (NFLOC). This means they need the kind of full-time care typically associated with a nursing home. Oklahoma uses the Activities of Daily Living as an evaluation metric to determine if an applicant requires NFLOC. These activities include mobility, bathing, dressing, eating, and toileting.
It is important to note that applicants must not give away their assets to become eligible for SoonerCare. Oklahoma has a Medicaid Look-Back Period of 60 months, during which the state will review the applicant's financial history to ensure no assets were sold or gifted below fair market value. If this rule is violated, the applicant will face a penalty period of ineligibility.
In addition to the financial and functional criteria, applicants must also meet residency and citizenship requirements. They must be Oklahoma residents and U.S. citizens or have proper immigration status.
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Treatment of assets for couples
In Oklahoma, Medicaid is called SoonerCare. It is jointly funded by the state and federal government and administered by the Oklahoma Department of Human Services (OKDHS). The program covers medical expenses for specific groups with limited income and resources. This includes low-income pregnant women, children, individuals who are elderly or have a disability, and parents and women with breast or cervical cancer.
In Oklahoma, all assets of a married couple are considered jointly owned, regardless of the long-term care Medicaid program for which one or both spouses are applicants. However, there are some exceptions and additional provisions for couples where only one spouse is a Medicaid applicant.
If only one spouse is a Nursing Home Medicaid or Medicaid Waiver applicant, only their income and assets are considered. The non-applicant spouse's income is disregarded and does not impact the applicant spouse's eligibility. The non-applicant spouse may be entitled to a Monthly Maintenance Needs Allowance (MMNA) from their applicant spouse to prevent financial hardship. In 2025, the MMNA in Oklahoma is $3,948. If the non-applicant spouse's monthly income is below this amount, income can be transferred from the applicant spouse to meet the MMNA threshold.
The non-applicant spouse of a Medicaid Nursing Home or Waiver applicant is also permitted a Community Spouse Resource Allowance (CSRA). In 2025, the community spouse can retain 50% of the couple's combined assets, up to a maximum of $157,920. If the non-applicant spouse's share of the assets is less than $31,584, they can retain 100% of the assets, up to this amount.
Couples where both spouses require Medicaid for long-term care in Oklahoma are allowed to keep $3,000 in assets. If only one spouse requires care, the other spouse is known as the Community Spouse. The Community Spouse is allowed to keep 50% of their assets up to $123,600 in countable assets. They can also keep 100% of their marital assets up to $25,000.
Additionally, certain assets are exempt from consideration for Medicaid eligibility in Oklahoma. These include personal belongings, household furnishings, an automobile, irrevocable burial contracts up to $10,000, and generally, one's primary home. Life insurance policies with a face value of up to $1,500 are also exempt.
The Oklahoma Long-Term Care Partnership Program allows policyholders to protect assets dollar-for-dollar based on the policy's maximum benefit payout. For example, a policy with a $165,000 maximum benefit would exempt $165,000 in assets from Medicaid eligibility calculations.
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Insure Oklahoma
To be eligible for Insure Oklahoma, an individual must be between the ages of 19 and 64, have a gross annual household income below the specified financial guidelines, and not be enrolled in Medicare or Medicaid. Additionally, they must either work for an Oklahoma business with 250 or fewer employees or be a small business owner with 250 or fewer employees who offers a qualified health plan to their employees and contributes at least 25% of the premiums for qualified employees.
Under the Employer-Sponsored Insurance (ESI) option, the costs of commercial health insurance premiums are shared by the state (60%), the employer (25%), and the employee (15%). Small businesses can save up to 60% on healthcare coverage costs for eligible employees by combining their insurance plans with Insure Oklahoma.
The Insure Oklahoma program is the first of its kind in assisting those who might otherwise lack access to medical care. Applications for Insure Oklahoma are available by contacting the program or through their website.
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SoonerCare
In Oklahoma, Medicaid is available to low-income individuals of all ages, including the elderly, disabled people, pregnant women, and children. The program covers medical expenses for those with limited income and resources. Oklahoma's Medicaid program is called SoonerCare.
SoonerSelect is the result of legislation passed in 2022 by the state, which contracted with private health and dental insurers to provide Medicaid benefits to eligible enrollees. This expansion of Medicaid in Oklahoma has made coverage available to non-elderly adults earning up to 138% of the poverty level, benefiting over 330,000 people.
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Frequently asked questions
Medicaid is a state/federal program that provides free or low-cost medical benefits to eligible low-income individuals of all ages.
Eligibility for Medicaid in Oklahoma is based on total family income and household size. The program covers medical expenses for the elderly, blind, disabled, pregnant women, and children under the age of 19.
Medicaid in Oklahoma offers a range of insurance plans, including SoonerCare, SoonerSelect, and Children's Health Insurance Program (CHIP). Additionally, private insurers provide Medicaid benefits, such as Wellcare's standalone PDP plan for prescription drugs and Ambetter of Oklahoma for quality healthcare solutions.
