SoonerCare to restart renewal process for members

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 riskbased 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 Sooner-Care, 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.

The first letter, printed on purple paper, will announce the end of the PHE. The ineligible member’s end date and the reason for the disenrollment will NOT be posted on this letter. All ineligible members will see an end date of April 30, 2023, at MySooner-Care.org until the second letter is sent.

The second letter, printed on white paper, will be sent to all ineligible members in March detailing their end date and the reason for disenrollment. Their new end date will be reflected at MySoonerCare.org.

A third letter, also printed on white paper, will be sent to ineligible members 45 days prior to their scheduled end date to inform them of the reason for loss of eligibility, potentially missing documents to verify eligibility and their appeal rights.

A fourth letter will be sent 10 days before the ineligible member loses eligibility.

OHCA will use multiple communications efforts to supplement the letters including electronic newsletters and social media.

“OHCA staff is heavily relying on community partners to be a resource through this disenrollment period,” said Traylor Rains, State Medicaid Director. “The Oklahoma Insurance Department is ready to help members find new coverage, as well as community partners, who have trained navigators ready to walk members through the process.”

There will be a special enrollment period on the Affordable Care Act Marketplace for those who lose their Medicaid coverage due to the public health emergency unwinding. The special enrollment period will stretch from March 31, 2023 to July 31, 2024. If a member is no longer eligible for SoonerCare, OHCA will send their information to the ACA Marketplace. To find local, in person help with finding a health care plan on the ACA Marketplace, members can go to www.healthcare. gov/find-assistance.

Marketplace plans are affordable with lowcost monthly premiums when federal subsidies are applied. These plans are comprehensive and cover prescription drugs, doctor visits, urgent care, hospital visits and more. Deductibles, copays and coinsurance apply.

More information about SoonerCare renewals can be found at MySoonerCare.org. OHCA encourages members to read the frequently asked questions document before calling the SoonerCare helpline to help OHCA serve members as quickly as possible.