OKLAHOMA CITY – Due to federal regulation passed in December, SoonerCare will soon restart the renewal process for members as the public health emergency continuous coverage ends. The Oklahoma Health Care Authority (OHCA) will begin the eligibility redetermination process in early March.
In March 2020, the Centers for Medicare & Medicaid Services (CMS) temporarily waived certain Medicaid requirements and conditions allowing people on Medicaid to continue their health coverage during the pandemic. Now states are required to resume eligibility reviews and disenroll those members no longer eligible.
OHCA estimates it will be required to disenroll approximately 300,000 ineligible Oklahoma adults and children from SoonerCare over a 9-month process while Oklahoma Human Services (OHS) staff will be required to disenroll the ineligible aged, blind, disabled population over a 12-month process. Both agencies will use a compassionate and intentional risk-based approach with the goal of protecting the most vulnerable members. Each member’s official end date will vary based on the approach to disenroll ineligible members.
“OHCA staff will review the circumstances for these members to determine if a member is higher or lower risk as determined by critical health conditions, financial need and benefit utilization,” said Kevin Corbett, Secretary of Health and Mental Health and OHCA CEO.
The first group, to be disenrolled starting April 30, 2023, will be members with an income above the Federal Poverty Level (FPL) eligibility limits who have no children under 5 years of age on SoonerCare and already have other major medical coverage. The second group to be disenrolled will be those who have an income above FPL eligibility limits, no children under 5 years of age on SoonerCare, and no claims and no other medical coverage on file.
“The agency understands the importance of a thoughtful strategy to limit coverage gaps particularly for those higher risk individuals currently utilizing services,' Secretary Corbett added. “We have support plans in place, as well as strong community leaders who are ready to help guide members into finding other resources for health care coverage.”
Members who are ineligible can expect to receive a round of four letters mailed from OHCA, beginning in February.