What is Covered?
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SoonerCare (Oklahoma Medicaid) covers many health care services. However, there are limitations that apply to ensure that only medically necessary services are provided. Some services are for children only. The benefits and coverage outlined here may change. Please check Chapter 30 of the OHCA Rules for the most up to date information.
Possible covered services
- Ambulance
- Ambulatory Surgery Center services
- Behavioral health and substance abuse services (outpatient)
- Case management services
- Chemotherapy and radiation therapy
- Child Health
- Clinic services including renal dialysis services
- Dental services (limited for adults)
- Dentures for adults residing in nursing facilities
- Durable Medical Equipment and supplies
- Family planning services and supplies
- Federally Qualified Health Center (FQHC) services
- Hemophilia
- Home health services
- Hospice
- Inpatient hospital services
- Inpatient hospital services in an institution for mental disease for people who are 65 years of age or older *
- Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) *
- Laboratory and X-ray services
- Medical supplies and equipment, including diabetic supplies
- Mental Health and Substance Abuse Services
- Nurse midwife services
- Nursing facility services *
- Nutritional Services
- Outpatient hospital services
- Pregnancy services (breastfeeding, etc.)
- Personal care services
- Physician services, including preventive services
- Podiatry services
- Prescription drugs and insulin
- Prenatal, delivery and postpartum services (maternity services)
- Quitting Smoking & Tobacco
- Rural health clinic services
- Transplants that are prior authorized
- Transportation to obtain covered medical care (SoonerRide)
- Tuberculosis services
- Ultrasound benefits
Additional services for children
- Hearing aids
- Immunizations
- Incontinence Supplies for certain children ages 4-20
- Incontinence Supplies (Spanish)
- Inpatient hospital services for patients in institutions for mental disease
- Optometric or optical services, including eyeglasses
- Orthodontics
- Other medically necessary services
- Physical and occupational therapy
- Private duty nursing
- Speech, hearing and language disorder services
The following programs may provide additional services or more restrictions to the services covered above for enrollees.
- Breast and Cervical Cancer Treatment Services (Oklahoma Cares)
- Family Planning services (SoonerPlan)
- Home and community-based services authorized under a waiver (In-Home Care)
Medicare Cost Sharing and Third Party Liability
SoonerCare pays only the deductibles and a portion of the co-insurance when any of the above items are covered by Medicare. OHCA also pays the monthly Medicare Part B premium for SoonerCare members age 65 or older and for certain blind or disabled persons. If an eligible person has other medical insurance, that insurance company must be billed before SoonerCare is billed.
