Medicaid agency: Oklahoma Health Care Authority (OHCA) / SoonerCare
Oklahoma Medicaid, branded SoonerCare, is administered by the Oklahoma Health Care Authority (OHCA), a standalone agency governed by its own nine-member board. Its SoonerSelect managed care program, which launched in 2024, delivers medical care through three comprehensive MCOs (Aetna Better Health of Oklahoma, Humana Healthy Horizons of Oklahoma, and Oklahoma Complete Health, with Oklahoma Complete Health also sole insurer for the Children's Specialty Program covering the child welfare population) and dental care through DentaQuest and LIBERTY Dental Plan; SoonerSelect runs under its own Section 1915(b) waiver, separate from SoonerCare's broader Section 1115 demonstration, in place since 1996 and currently on a bridge extension through 2026 pending a longer-term renewal. Oklahoma expanded Medicaid via State Question 802, a 2020 ballot measure that added a state constitutional provision, Article XXV-A, barring additional eligibility burdens on the expansion population beyond what applies to other Medicaid populations; that protection remains unchanged after the 2026 Legislature considered, but did not enact, measures that would have altered it. Federal work requirements take effect January 1, 2027, requiring expansion-age adults to document 80 hours of monthly qualifying activity against an 18-category exemption list, with a 30-day window after an initial adverse determination; OHCA estimates roughly 126,000 Oklahomans could be affected, and Oklahoma has not joined the multistate lawsuit challenging the CMS rule that narrowed the medically-frail work-requirement exemption. Oklahoma runs its Children's Health Insurance Program combined with Medicaid under the same SoonerCare umbrella, covering children up to 205% of the federal poverty level, alongside two smaller CHIP-funded programs: Soon-to-be-Sooners, prenatal coverage for the unborn children of income-eligible pregnant women, and Insure Oklahoma, employer-sponsored-insurance premium assistance.
CMS's most recent managed care enrollment data, report year 2024, shows Oklahoma's SoonerSelect transition still underway rather than complete. The three SoonerSelect comprehensive MCOs (Aetna Better Health of Oklahoma, Humana Healthy Horizons of Oklahoma, and Oklahoma Complete Health) each report between roughly 186,000 and 191,000 members, while the same year's data also lists 184,226 members still in SoonerCare Choice, the legacy primary-care case-management program SoonerSelect replaced. The two dental plans, DentaQuest and LIBERTY Dental Plan, appear as separate dental-only Prepaid Ambulatory Health Plans covering 278,611 and 334,901 members respectively. Aged, blind, and disabled beneficiaries, dual eligibles, individuals at a nursing-facility level of care, and several presumptive-eligibility categories are excluded from SoonerSelect and remain on SoonerCare Traditional fee-for-service; Oklahoma also runs three Programs of All-Inclusive Care for the Elderly outside SoonerSelect (Cherokee Elder Care, Life PACE, and Valir PACE), together covering just under 800 members.
Long-term services and supports sit outside the SoonerSelect MCO contracts; members needing nursing-facility or intermediate-care-facility-level care remain on SoonerCare Traditional fee-for-service, served instead through six active Section 1915(c) home- and community-based waivers: ADvantage, Community Waiver, Homeward Bound, In-Home Supports Waiver for Adults, In-Home Supports Waiver for Children, and Medically Fragile. OHCA holds federal Medicaid authority for the ADvantage waiver, but day-to-day administration runs through Oklahoma Human Services' Community Living, Aging and Protective Services division.
Not integrated into managed care
Behavioral health is capitated directly into each SoonerSelect MCO's contract alongside physical health; plans cover all medically necessary health and behavioral health services except dental. There is no separate behavioral health PIHP or PAHP for the SoonerSelect population.
Carved in
DentaQuest and LIBERTY Dental Plan have administered SoonerSelect's dental benefit statewide since February 2024, two months before the medical and Children's Specialty Program plans launched. Each operates as a separate dental-only Prepaid Ambulatory Health Plan rather than through the medical MCOs.
Express Scripts administers the pharmacy benefit directly for Oklahoma Complete Health's SoonerSelect members, continuing the same relationship the plan used under fee-for-service. Aetna Better Health and Humana do not name their own pharmacy benefit manager on their public Oklahoma materials.
ModivCare, operating in Oklahoma as LogistiCare Solutions, LLC (the name still used on OHCA's own SoonerRide materials), brokers non-emergency medical transportation statewide for SoonerCare Traditional and SoonerCare Choice, the fee-for-service and legacy primary-care case-management populations. SoonerSelect members arrange non-emergency transportation through their own MCO instead of through SoonerRide.
Gainwell Technologies operates Oklahoma's Medicaid Management Information System and serves as fiscal agent.
227 agency updates tracked for Oklahoma. Available with Pro.
See them with ProIn a Becker's Hospital Review report, Arbuckle Memorial Hospital CFO Denise Welch describes how the Sulphur, Oklahoma critical access hospital is preparing its 2027 budget amid financial pressure. The hospital plans to cut staffing redundancies and hold outside contract spending flat rather than reduce wages, which Welch says would hurt amid competitive labor markets. Welch said the hospital will continue investing in technology and informatics infrastructure to avoid care delays and reduce outside exposure, while updating fully depreciated building infrastructure to maintain its current reimbursement status. The comments illustrate budget tradeoffs facing small rural hospitals heading into 2027.
Oklahoma's Department of Mental Health is privatizing four state-run certified community behavioral health clinics, with over 90% of affected state employees receiving job offers as part of the transition. The privatization effort shifts clinic operations from direct state management to private providers. The timing and effective date of the transition were not specified in the report. This matters for states considering similar CCBHC delivery model changes and for understanding workforce continuity during Medicaid behavioral health delivery system transitions.
The Oklahoma Health Care Authority has notified over 250,000 SoonerCare enrollees that new federal work requirements may affect their Medicaid eligibility. Yellow letters were mailed last week instructing recipients how to maintain coverage. The state agency is implementing the federal mandate, which would require certain adult Medicaid beneficiaries to meet work, training, or community engagement activities to remain eligible. Implementation timing and specific exemption categories were not detailed in the announcement.
The Oklahoma Department of Mental Health and Substance Abuse Services has awarded one-year contracts to four private providers to deliver behavioral and mental health services in portions of the state, transitioning from direct state operations to a privatized model. The shift affects regional service delivery and represents a structural change in how Oklahoma delivers public behavioral health care. Contract terms and implementation timelines were not specified in the announcement. This change may create new network and coordination requirements for Medicaid managed care organizations operating behavioral health programs in Oklahoma.
Ascension St. John Nowata in Oklahoma has applied to the state health department to convert from a critical access hospital to a rural emergency hospital designation. The facility would maintain 24/7 emergency services and outpatient care under the REH model. The conversion reflects a broader trend of rural hospitals adopting the REH designation created under the Consolidated Appropriations Act of 2021, which allows hospitals to eliminate inpatient beds while maintaining emergency and outpatient services with enhanced Medicare reimbursement.
12 active waivers tracked for Oklahoma. Available with Pro.
See them with ProNo active solicitations currently tracked for Oklahoma.
9 managed care contracts tracked for Oklahoma. Available with Pro.
See them with Pro77 bills tracked for Oklahoma. Available with Pro.
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