SoonerCare 1115(a) Research and Demonstration Waiver Amendment Request

With this amendment, the OHCA seeks the following modifications to the 1115(a) Demonstration Special Terms and Conditions (STCs), upon CMS approval through the end of the next waiver Demonstration period on December 31, 2028:

• Add Pregnant Women with incomes between 134 percent and 185 percent of Federal Poverty Level (FPL) converted to the Modified Adjusted Gross Income (MAGI) equivalent plus applicable disregards (210 percent of FPL) under the Demonstration for the purpose of enrolling this Group in the SoonerCare fee-for-service Patient Centered Medical Home (PCMH) model.
  
  
• Extend the retroactive eligibility waiver exclusion for Pregnant Women with incomes up to 185 percent of Federal Poverty Level (FPL) converted to the Modified Adjusted Gross Income (MAGI) equivalent plus applicable disregards (210 percent of FPL), from 60-days postpartum to 12-months postpartum. 
  
  
• Add American Indian/Alaska Native (AI/AN) members with IHS creditable coverage under the Demonstration for the purpose of enrolling this Group on a voluntary basis in the SoonerCare Choice fee-for-service Patient Centered Medical Home (PCMH) model.
  
  
• Exclude individuals enrolled in risk-based managed care from the Demonstration, unless they are subject to the waiver of retroactive eligibility.

Please view the waiver amendment document here and submit feedback via the comment box below.

Tribal Consultation Period: 12/29/2022 – 2/27/2023

Tribal Consultation Meeting: 01/03/2023

Circulation Date: 01/27/2023

Comment Due Date: 02/27/2023