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Medicaid in Oklahoma

Authored By: OKDHS
Contents

Information

In order to qualify for this benefit program, you must be:

  • a resident of the state of Oklahoma,
  • a U.S. national, citizen, permanent resident, or legal alien
  • who has been in the United States at least five years,
  • in need of health care/insurance assistance,
  • whose financial situation would be characterized as low income or very low income.
  • You must also be either pregnant, a parent or relative caretaker of a dependent child(ren) under age 19, blind, have a disability or a family member in your household with a disability, or be 65 years of age or older.

 

SoonerCare, Oklahoma's Medicaid program, provides health care to children under the age of 19, adults with children under the age of 18, pregnant women and people who are older than 65 or have blindness or another disability. The following programs are a part of SoonerCare: Aged, Blind and​ DisabledFamily PlanningHealth Care for Children with Disabilities (TEFRA); and Health Screening, Diagnosis and Treatment (EPSDT).

Adults with children under age 18

  • Recipients of the Temporary Assistance to Needy Families (TANF) program are automatically eligible for health benefits. 
  • Adults with children under the age of 18 who do not receive TANF may, in some circumstances, also be eligible for medical services. The income guidelines are presented in Appendix C-1 Schedule X. (Resources are not considered with this group.) 

Children under age 19 and pregnant women

  • Children under the age of 19 and pregnant women whose family incomes meet the income guidelines in Appendix C-1 Schedule I.A may be eligible for medical benefits. (Resources are not considered with this group).

Aged, Blind or Disabled

  • Individuals who are 65 or older are eligible if they meet the financial criteria.
  • To be eligible for medical benefits in Oklahoma, a person will need to apply for and receive a disability determination from the Social Security Administration. To be considered disabled, a person must have a physical or mental impairment, disease or loss that appears reasonably certain to continue at least 12 months without significant improvement and that substantially impairs his/her ability to perform labor or services or to engage in a useful occupation.
  • In addition, people eligible for Medicare Part A may qualify to have medical benefits pay their Medicare premiums, co-payments and deductibles as a Qualified Medicare Beneficiary (QMB), a Qualified Disabled and Working Individual (QDWI) or a Specified Low Income Medicare Beneficiary (SLMB).  (Get more information about these programs).
  • The recipient's monthly income and resources must meet guidelines listed in Appendix C-1 (.pdf,  8 pp,  316 KB) (Schedule V-VII for help with Medicare premiums and Schedules VI and VIII for medical assistance).
  • People who belong to the "aged, blind and disabled" group may also qualify for a State Supplemental Payment.

How to Apply

If you are not on medical benefitscontact your local DHS Human Services Center and file an application. 

You will file one of two applications, depending on the group to which you belong. (See group descriptions above.)

Applying for medical assistance for families with a member under 18, caregivers of children under the age of 19 or pregnant women. Oklahoma Health Care Authority will be accepting and processing applications for this group.Go to My SoonerCare (opens in a new window) to apply online. You can still go to anOKDHS Human Services Center. to get help applying or get an application.

Persons with disabilities, blindness or who are older than the age 65, must fill out form 08MP003 - PDF DHS Human Services Center.

Contact

If you have questions about eligibility for these programs, please contact your DHS Human Services Center.

Information

In order to qualify, you must have an annual household income (before taxes) that is below the following amounts:

Household Size* Maximum Income Level (Per Year)
1 $15,800
2 $21,307
3 $26,813
4 $32,319
5 $37,825
6 $43,331
7 $48,851
8 $54,384

*For households with more than eight people, add $5,533 per additional person. Always check with the appropriate managing agency to ensure the most accurate guidelines.

Last Review and Update: Feb 05, 2019
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