SoonerSelect FAQ for Members

SoonerSelect is a health care delivery system used to coordinate health and dental care and to improve quality of care. The Oklahoma Health Care Authority (OHCA) will partner with health and dental plans to coordinate the care for most members. SoonerSelect provides Medicaid health benefits through contracted arrangements between state Medicaid agencies, health plans and dental plans.

Note: You may hear phrases such as contracted entities (CEs) or provider-led entities (PLEs) to describe health plans and dental plans.

The change in health care delivery will allow OHCA to:

• Improve health outcomes for Oklahomans
• Move toward a system where we pay providers based on the quality of care they provide to Oklahomans rather than just by service
• Improve member satisfaction
• Focus on preventive and primary care

All health/dental plans will provide the same health care services currently offered by SoonerCare. Each plan may also offer extra benefits to help you and other members be healthier.

The following SoonerCare groups will be enrolled in SoonerSelect:

• Children, including foster children
• Low-income parents
• Pregnant women
• Non-disabled adults ages 19-64

American Indian/Alaska Native members can choose to opt-in to a SoonerSelect plan but will not be required to.

If you are changing to SoonerSelect, OHCA will ask you to pick one dental plan and one health plan. You can compare the benefits of each plan and pick the right plan for you.

There are three SoonerSelect programs.

SoonerSelect Dental Program
SoonerSelect members will enroll in a dental plan. Dental plans will cover medically necessary preventive and restorative dental care. Additionally, medically necessary orthodontic services will be available for children under 21.

SoonerSelect Health Program
SoonerSelect members will enroll in a health plan. You will have a chance to choose a health plan. If you do not choose one, a plan will be assigned. Health plans will cover medically necessary prescriptions, health services and behavioral health services, except dental services.

Children’s Specialty Program
The SoonerSelect Children’s Specialty Program (CSP) will serve members involved in the juvenile justice system and those served by Oklahoma Human Services. This includes children in foster care and children receiving adoption assistance. The CSP provides medically necessary prescriptions, health care services and behavioral health services that focus on the unique health needs of the children it serves. It places special emphasis on early identification of needs and interventions.

All health and dental plans will provide coverage to SoonerSelect members in all of Oklahoma's 77 counties.

All health/dental plans will provide SoonerSelect members with the same health care services currently offered by SoonerCare. There are no changes to pharmacy benefits. There are also no changes to eligibility requirements. Health/dental plans can offer extra benefits to help improve the health of SoonerSelect members. You will be able to compare extra benefits provided by each plan and pick the right one for you.

There is no extra cost for enrolling in a SoonerSelect plan.

Each health/dental plan will have its own network of providers. The availability of specific providers may vary from plan to plan. If you have a doctor or other provider you want to keep seeing, you should pick a health/dental plan that has your provider in the plan’s network. During sign-up, when you are picking your plans, each plan will have a provider directory on its website that you can review. OHCA member service representatives will also be available to help you with this process.

You will have the chance to pick your dental and health plans. SoonerCare representatives can help you pick the plan that best suits your needs. During the sign-up period, you can enroll by logging in to www.MySoonerCare.org or calling the SoonerCare Helpline at 800-987-7767.

Beginning late fall of 2023, you will begin receiving information on available plans and where to go to get more information on SoonerSelect programs.

Yes. You should make sure your case and contact information (address, phone number and email address) are up to date so when the time comes, you can receive critical information about SoonerSelect. You can do this by visiting www.MySoonerCare.org.

No; however, some members may be responsible for copays for certain benefits. To view information related to cost sharing, click here.

Insure Oklahoma is separate from SoonerSelect. If you are eligible for Insure Oklahoma, you are not eligible for SoonerSelect.

Only certain SoonerCare populations will enroll in a SoonerSelect plan. The following SoonerCare groups will be enrolled in SoonerSelect:

• Children, including foster children
• Low-income parents
• Pregnant women
• Non-disabled adults ages 19-64

Not all SoonerCare populations will move to SoonerSelect. The following individuals will be excluded from enrollment in SoonerSelect and will still have services administered by the Oklahoma Health Care Authority:

• Dual eligible Individuals 

• Individuals enrolled in the Medicare Savings Program, QMB, SLMB, QDW and QIs.

• Persons with a nursing facility or Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IID) level of care (LOC) 

• Individuals during a period of presumptive eligibility

• Individuals infected with tuberculosis eligible for tuberculosis-related services  

• BCC enrolled individuals

• Individuals enrolled in a § 1915(c) waiver  

• Undocumented persons eligible for emergency services only 

• Insure Oklahoma ESI dependent children 

• Coverage under Soon-to-be-Sooners

• ABD individuals

• OOS inquiries

• Populations that remain enrolled due to the continuous enrollment and maintenance of effort (MOE) requirement of the Families First Coronavirus Response Act (FFCRA)

American Indian/Alaskan Native (AI/AN) Members

Eligible American Indian/Alaskan Native (AI/AN) members will have the opportunity to opt in to SoonerSelect. If AI/AN members do not opt in to SoonerSelect, they will remain in their current SoonerCare program and will continue receiving services in the same way. If an AI/AN member opts in but does not pick a plan, OHCA will assign a SoonerSelect plan to the member. AI/AN members can opt in and enroll with a SoonerSelect plan by: 

1. Logging into their MySoonerCare.org account and selecting “change plan/provider.” From there, the enrollee can choose to opt in and select their plan of choice.

2. Calling the choice counseling line at 800-987-7767 to ask questions, receive information on plans, choose to opt in, or to select or change plans.  

The plan the enrollee is enrolled with the day the lock-in period starts (90 days post initial enrollment) is the plan the enrollee will remain in until the next open enrollment period. AI/AN enrollees can request disenrollment from their plan without a good cause reason.  If an AI/AN member chooses not to enroll or to enroll then disenroll, the AI/AN member will be able to opt in again at the next open enrollment period. 

FFCC and children receiving adoption assistance

The SoonerSelect Children’s Specialty Program is the health care plan that covers all Medicaid services (other than dental) for children in foster care, former foster care children (FFCC), juvenile justice involved children and children receiving adoption assistance.

FFCC and children receiving adoption assistance will be enrolled in the SoonerSelect Children’s Specialty Program automatically. If you are part of these groups, you may opt out of enrollment in the SoonerSelect Children’s Specialty Program and enroll with a SoonerSelect plan.

Former foster care children may opt out of enrollment in the SoonerSelect Children’s Specialty Program and enroll with a SoonerSelect plan by:

1. Logging into your MySoonerCare.org account and selecting “change plan/provider.” From there, select the plan in which you would like to enroll.

2. Calling the choice counseling line at 800-987-7767 to ask questions, receive information on plans, or to select or change plans.

Children receiving adoption assistance may opt out of enrollment in the SoonerSelect Children’s Specialty Program and enroll with a SoonerSelect plan by:

1. Calling the SoonerCare helpline at 800-987-7767 to ask questions, receive information on plans, or to select or change plans.

You can change your plan within the first 90 days after enrollment. The period after the first 90 days until the next open enrollment period is called the lock-in period. Once the lock-in period begins, you will remain in your plan until the next open enrollment period unless a disenrollment request is approved, or you become ineligible for SoonerSelect.

Children in Tribal custody

Children in tribal custody and juvenile justice involved children can voluntarily enroll into SoonerSelect Children’s Specialty Plan by choosing to opt in. This population is able to voluntarily enroll in the SoonerSelect Children’s Specialty Plan at any time. If they would like to enroll in a SoonerSelect plan, they can do so by:

1. Calling the SoonerCare helpline at 800-987-7767 to ask questions, receive information on plans, or to select or change plans. 

The plan the enrollee is enrolled with the day the lock-in period starts (90 days post initial enrollment) is the plan the enrollee will remain in until the next open enrollment period. AI/AN enrollees can request disenrollment from their plan without a good cause reason.