Medicaid Unwinding in Oklahoma: What You Need to Know If You Lose Coverage
Key takeaways:
Medicaid renewals in Oklahoma are changing because of the end of the COVID-19 public health emergency (PHE) on May 11, 2023. This is being called the unwinding of Medicaid, and some people will lose coverage during this process.
During the PHE, Medicaid renewals were automatic, and enrollees had continuous coverage. As part of the unwinding process, automatic renewals for Medicaid and the Children’s Health Insurance Program (CHIP) stopped nationwide on March 31, 2023.
Oklahoma Medicaid — known as SoonerCare — has started reviews to see who is eligible to continue receiving coverage. Make sure the Oklahoma Health Care Authority has your current contact information. If they can’t reach you, or if you’re no longer eligible for Medicaid, you could lose coverage as early as May 1, 2023.
If you lose SoonerCare coverage during the unwinding, you may qualify for a low-cost, alternative health insurance option, such as an Affordable Care Act marketplace plan.
The U.S. Department of Health and Human Services declared a public health emergency (PHE) for COVID-19 in January 2020. The PHE was renewed a dozen times between January 2020 and February 2023.
People who were eligible for Medicaid coverage at the start of the PHE were able to keep their insurance during the pandemic — even if they were no longer eligible. This is because all 50 states — including Oklahoma — were mandated to provide continuous coverage during the PHE.
But now that the PHE is officially ending in May 2023, automatic renewals for Medicaid will also end. This process is already underway and could cause 5 million to 14 million enrollees nationwide to lose coverage.
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Oklahoma has resumed eligibility reviews for Medicaid and Children’s Health Insurance Program (CHIP) enrollees. This is called the redetermination process. Anyone who no longer qualifies could be disenrolled as early as May 1, 2023. In fact, the Oklahoma Health Care Authority (OHCA) estimates that 300,000 people in the state could lose Medicaid or CHIP coverage.
Here’s what you need to know about Medicaid changes in Oklahoma, and what to do if you lose your insurance coverage.
Why is Medicaid changing nationwide?
After the PHE ends, COVID-19 will remain a public health priority — just not an emergency. As part of this process, Medicaid renewals will no longer be automatic. This is being referred to as the unwinding of Medicaid.
The unwinding will affect Medicaid in every state, Washington, D.C., and five U.S. territories.
What’s happening with Medicaid renewal in Oklahoma?
The Oklahoma Health Care Authority (OHCA) is responsible for overseeing the state’s Medicaid program, which is known as SoonerCare. OHCA has a redetermination plan that outlines how the state plans to conduct eligibility reviews for current enrollees.
OHCA will perform eligibility reviews for a year. The state will prioritize high-risk cases, such as households with children under 5 or with higher financial need, and enrollees in the middle of an episode of care.
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Some SoonerCare enrollees will be passively renewed, meaning that the OHCA has enough information to confirm their eligibility. If you need to provide the agency with additional information, you will be notified with a purple letter.
It’s important for you to confirm or update your household’s contact information with OHCA. You can confirm or update your information by:
Logging in to your account on the SoonerCare member portal
Calling the the SoonerCare helpline at 1-800-987-7767
The state has launched an outreach campaign about Medicaid renewal and is sending reminders that may reach you via:
Mail
Email
Text message
Robocall
Messaging when you are on hold by phone
Social media
Press releases to news media
Resources from community organizations, healthcare providers, and tribal partners
If you need to reach Oklahoma Medicaid by phone, call the SoonerCare helpline at 1-800-987-7767.
Tribal health and Medicaid unwinding
OHCA liaisons are reaching out to people who are enrolled in Medicaid and who are also members of or affiliated with Native American tribes. The National Indian Health Board estimates that as many as 236,000 American Indians and Alaska Natives (AI/AN) could lose coverage during the unwinding process. This population includes an estimated 15,511 to 16,501 AI/AN people in Oklahoma.
What should I do if I lose my Medicaid coverage in Oklahoma?
In order to receive Medicaid in Oklahoma, you must meet all of the following criteria:
You must be an Oklahoma resident.
You must be a U.S. citizen, permanent resident, or legal resident.
You must need assistance with healthcare or insurance coverage.
Your annual household income before taxes must be below the limit for your household size.
In Oklahoma, you may also qualify if you are:
Pregnant
A child or teenager
Responsible for the care of a child who is 18 years old or younger
Blind
65 years old or older (and meet certain criteria)
A person with a disability, or you have a person in your household who has a qualifying disability
A former foster child
In need of nursing home care
Age 19 and older with family planning needs
In need of treatment for breast or cervical cancer (and have been screened or are still undergoing treatment)
If you no longer qualify or OHCA can’t reach you, you will lose your benefits, which could leave you temporarily uninsured.
You should find out if you are losing coverage through three letters:
An initial notification letter will indicate when your coverage is ending for one or more enrollees in your household.
A second letter will indicate the reason you’re no longer eligible, your coverage end date, and your appeal rights. This letter should arrive 45 days before your coverage end date.
A third letter will be sent 10 days before you lose coverage.
If you lose your coverage but believe you still qualify, you can reapply for SoonerCare. You may be uninsured for a while until you’re approved for coverage again.
If you choose not to reapply for Medicaid coverage, or if you’re no longer eligible, you may qualify for another low-cost or free healthcare option. You can also use GoodRx coupons to save on your prescription medications. In addition, you may be able to enroll in an alternative health insurance plan such as:
Affordable Care Act (ACA) marketplace: You may be able to find an ACA health plan for $10 or less per month if you qualify for a premium subsidy. If you lose SoonerCare, you can purchase a plan in the ACA marketplace during the unwinding special enrollment period from March 31, 2023 to July 31, 2024.
Employer plan: Your company may offer employer-sponsored health insurance.
Medicare: If you have a qualifying disability or condition — such as end-stage renal disease or ALS (amyotrophic lateral sclerosis), commonly referred to as Lou Gehrig’s disease — you can enroll in Medicare at any age.
Partner’s plan: If you have a spouse or domestic partner who has insurance, you may be able to join their plan during an open enrollment or special enrollment period.
Special plans: Short-term insurance can be a great choice if you anticipate a better option, like job-based health insurance, to be available soon. You may also consider alternative and limited-benefit plans, such as fixed indemnity, accident, cost-sharing, and catastrophic insurance plans.
Student health plan: If you’re enrolled in a college or university, you may be eligible for a campus health plan.
U.S. Department of Veterans Affairs (VA): If you are an active-duty service member or a veteran, you may qualify for TRICARE coverage or VA benefits and services.
Oklahoma Medicaid resources
Here are some resources where you can learn more about Medicaid in Oklahoma and upcoming changes related to the end of the public health emergency:
Oklahoma Medicaid office: The Oklahoma Health Care Authority oversees and administers the state’s Medicaid program, which is called SoonerCare.
Oklahoma Medicaid self-service portal: You can visit the SoonerCare member portal and access your account online 24/7 to confirm or update your contact information.
Oklahoma Medicaid redetermination: Read more about Oklahoma’s Medicaid redetermination plan.
Oklahoma Medicaid office phone assistance: You can call the SoonerCare helpline at 1-800-987-7767.
The bottom line
Automatic Medicaid renewals stopped on March 31, 2023 in advance of the COVID-19 public health emergency’s conclusion on May 11, 2023. This could mean a loss of coverage for people who have SoonerCare — Oklahoma’s version of Medicaid and the Children’s Health Insurance Program (CHIP).
The Oklahoma Health Care Authority (OHCA) will be reviewing cases for eligibility over the next year. The agency estimates that 300,000 people could be disenrolled in SoonerCare during the process. Make sure that OCHA has your current contact information, or you could miss important notifications — which could also lead to a loss of coverage. If you are going to be disenrolled, OCHA will notify you at least 45 days before your scheduled coverage end date.
If you lose your SoonerCare, you may still qualify for health insurance elsewhere. Your options may include ACA marketplace plans, Medicare, or job-based insurance.
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References
Centers for Medicare & Medicaid Services. (n.d.). Unwinding and returning to regular operations after COVID-19.
National Indian Health Board. (2023). Medicaid unwinding. Tribal Health Reform Resource Center.
Oklahoma Health Care Authority. (2023). About Insure Oklahoma.
Oklahoma Health Care Authority. (2023). Eligibility guidelines.
Oklahoma Health Care Authority. (2023). Oklahoma public health emergency unwinding approach.
Oklahoma Health Care Authority. (2023). SoonerCare and Insure Oklahoma income guidelines - 2023.
Oklahoma Health Care Authority. (2023). SoonerCare renewals are coming back.
Oklahoma Health Care Authority. (2023). SoonerCare to restart renewal process for members.
Tolbert, J., et al. (2023). 10 things to know about the unwinding of the Medicaid continuous enrollment provision. Kaiser Family Foundation.
U.S. Administration for Strategic Response and Preparedness. (2020). Determination that a public health emergency exists.
U.S. Administration for Strategic Response and Preparedness. (2023). Renewal of determination that a public health emergency exists.
U.S. Department of Veterans Affairs. (2022). VA & TRICARE information.
