Understanding Medicaid Eligibility in Oklahoma

1. Understanding Medicaid Eligibility in Oklahoma Accessing healthcare can feel overwhelming, especially if you are unsure whether you qualify for assistance programs like Medicaid. For many individuals and families, Medicaid provides a critical lifeline, covering essential health services that might otherwise be unaffordable. Understanding the Medicaid eligibility criteria in Oklahoma can help you and your family get the care you need. What Is Medicaid? In Oklahoma, Medicaid is known as SoonerCare. The program can cover a broad range of services, including doctor visits, hospital stays, mental health services, and preventive care. Many providers, including Community Health Centers (CHCs), accept Medicaid, making it an invaluable option for those needing affordable healthcare. Medicaid is more than just a program; it is a gateway to better health for thousands of Oklahomans! By providing individuals and families access to preventative and ongoing care, Medicaid reduces the need for costly emergency services and improves overall health outcomes. It gives peace of mind for many, knowing that essential healthcare services are within reach. Who Qualifies for Medicaid in Oklahoma? Medicaid eligibility in Oklahoma depends on several factors, including income, family size, and specific needs. The following groups are generally eligible: Low-Income Families and Children. Families with children under 19 often qualify, with income thresholds adjusted based on family size. ● Pregnant Women. Expectant mothers with low incomes may qualify for prenatal, delivery, and postpartum care under Medicaid. ● Seniors and People with Disabilities. Individuals 65 or older and those with qualifying disabilities may qualify for Medicaid or dual eligibility with Medicare. ● Adults without Children. As of July 2021, Oklahoma expanded Medicaid to include low-income adults aged 19 to 64 who meet income requirements. ● The state uses the Modified Adjusted Gross Income (MAGI) standard to determine eligibility for most groups. You can determine your income eligibility online or contact OKPCA for assistance in determining your qualifications.

2. Are the Medicaid Eligibility Criteria the Same in Oklahoma as in Other States? Eligibility criteria vary from state to state, as the program is administered at the state level under federal guidelines. While certain groups—such as low-income families, pregnant women, seniors, and individuals with disabilities—are generally covered in most states, the specific income limits and additional qualifying factors can differ significantly. If you have recently moved to Oklahoma or another state, reviewing the specific Medicaid eligibility criteria for that state is essential. 3 Steps to Determine Eligibility for SoonerCare If you think you may qualify for Medicaid, follow these steps: 1. Check Your Income. Review Oklahoma’s income limits for Medicaid, which vary by household size and category. 2. Gather Necessary Documents. Prepare proof of income, identification, and other required information. 3. Submit Your Application. Apply for Medicaid through Oklahoma’s online SoonerCare application portal. If you meet specific criteria, you may also be able to apply through your local county DHS office. Where Can Medicaid Beneficiaries Receive Care? Community Health Centers play a critical role in meeting the needs of Medicaid recipients. Also called Federally Qualified Health Centers, these centers are designed to serve underserved communities, offering comprehensive care at affordable rates. Even if you are in the process of applying for Medicaid, waiting for approval, or were not accepted, health centers can provide care based on a sliding fee scale, so financial challenges do not prevent you from seeking medical attention. Key benefits of visiting a CHC include: Accessibility. With locations across the state, health centers ensure that care is available close to home. ● Comprehensive Services. From routine medical care to dental and vision services, health centers offer a variety of essential services. ● Continuity of Care. Health centers focus on building long-term relationships with their patients, offering consistent, coordinated care to improve overall health ●

3. outcomes in the community. Receive Care at Your Local Federally Qualified Health Centers At the Oklahoma Primary Care Association (OKPCA), we work to support Community Health Centers that provide affordable healthcare to all Oklahomans. If you are unsure whether you qualify for Medicaid or need help finding a CHC that fits your needs, we are here to guide you! Our goal is to connect you to the care you deserve, ensuring that financial concerns never stand in the way of your health. Please use our interactive map to find a health center near your community or contact us for assistance.