SoonerCare Choice/Insure Oklahoma Waiver

The waiver was implemented in 1996 following approval by the Centers for Medicare & Medicaid Services and is currently approved through Dec. 31, 2023. This authority has allowed OHCA to expand health care services to members and providers through the development of SoonerCare Choice and Insure Oklahoma. Other beneficial programs including the patient-centered medical home, health management program, Health Access Network pilot program and the SoonerExcel incentive payment program have also been established under the waiver.

Additionally, the SoonerCare Choice/Insure Oklahoma waiver has allowed the state to extend eligibility to include individuals that would not otherwise qualify for coverage including:

Adults and full-time college students eligible for Insure Oklahoma with a household income up to 200% FPL
Children of parents covered by Insure Oklahoma

Please visit OHCA's SoonerCare Choice or Insure Oklahoma websites for more information on qualifications and benefits.

OHCA and CMS negotiate and agree upon special terms and conditions (often referred to as “the waiver”) which includes:

CMS Approval Letter

Received by OHCA on Jan. 31, 2022, the demonstration’s most recent approval letter from CMS outlines the reasons for amendment approval as well as the amendment’s effective date of Jan. 31, 2022 through Dec. 31, 2023.

OK SoonerCare 1115 Demo Approval Letter

Waiver List

A listing of the waivers of federal law or regulation that are necessary to establish and maintain Oklahoma’s SoonerCare Choice and Insure Oklahoma programs under the approved section 1115 Medicaid demonstration.

OK SoonerCare 1115 Demo Waiver List

Expenditure Authorities

A listing of the specific expenditure authorities CMS will allow the state to make, with federal matching funds included, on items, programs or services that were not previously allowed, but are permitted under the demonstration.

OK SoonerCare 1115 Demo Expenditure Authority

SoonerCare Choice/Insure Oklahoma Special Terms and Conditions

The numerous special terms and conditions CMS requires Oklahoma meet to fulfill the State’s obligations under the demonstration, including eligibility, program benefits and cost sharing, delivery systems, monitoring and reporting requirements, and much more.

OK SoonerCare 1115 Demo STCs

CMS also posts the waiver with any accompanying amendments, extensions or renewals. Visit Medicaid.gov for more information on the SoonerCare/Insure Oklahoma waiver.

OHCA is required to report to CMS semi-annually as well as annually and provides a comprehensive program evaluation for each waiver timeframe approved, generally every three years. In addition, OHCA has submitted a proposed evaluation design for the next three-year approval period.

SoonerCare Choice Annual Reports

Budget neutrality workbooks are submitted to CMS separate from annual/semiannual reports. To locate any attachments submitted with each report, including the budget neutrality workbook, download the file, open in a PDF reader, and click the paperclip at the top left.

SoonerCare Choice Semi-Annual Reports

Budget neutrality workbooks are submitted to CMS separate from Annual/Semi-Annual reports. To locate any attachments submitted with each report, including the budget neutrality workbook, download the file, open in a PDF reader, and click the paperclip at the top left.

Evaluation Design and Reports

Click here to view the CMS-approved Evaluation Designs and Reports.

Last Modified on Aug 30, 2024