Oklahoma has recently transitioned a significant portion of its Medicaid program, known as SoonerCare, into a new delivery model called SoonerSelect. This shift represents a move toward managed care, where private organizations coordinate healthcare services for members. The goal of this change is to improve health outcomes by focusing on preventative care, care coordination, and providing additional benefits that go beyond traditional Medicaid services.
If you are a member of SoonerCare, understanding how SoonerSelect works is essential for maintaining your coverage and accessing the doctors you need. This guide provides a clear overview of the program, the different health plan options available, and the steps you need to take to choose the best fit for your family.
What is SoonerSelect?
SoonerSelect is the name of Oklahoma’s managed care program for specific groups of Medicaid members. Under this system, the Oklahoma Health Care Authority (OHCA) contracts with private health insurance companies, known as Managed Care Organizations (MCOs), to provide healthcare services. Instead of the state paying doctors directly for every visit, the state pays these MCOs a set monthly fee to manage your care.
This model is designed to provide members with a more “whole-person” approach to health. MCOs are incentivized to keep members healthy through regular checkups and disease management programs. For members, this often means more personalized support, such as having a dedicated care coordinator to help navigate complex medical needs.
Who is Eligible for SoonerSelect?
Not everyone currently enrolled in SoonerCare will move to SoonerSelect. The program is specifically designed for certain populations, including children, pregnant women, and low-income parents or caretakers. Most healthy adults who qualified under the Medicaid expansion also fall into this category.
However, some groups will remain in the traditional SoonerCare fee-for-service model. This includes individuals receiving services through certain waivers, those in long-term care facilities, and individuals with specific complex medical needs. If you are eligible for SoonerSelect, you should have received a notification from the Oklahoma Health Care Authority informing you of the transition and your need to select a plan.
The Three Main Health Plan Options
When you enroll in SoonerSelect, you have the opportunity to choose between three primary health plans. Each plan offers the same basic Medicaid benefits required by the state, but they differ in their networks of doctors and the “value-added” benefits they provide. The three current partners are:
- Aetna Better Health of Oklahoma: Aetna focuses heavily on community-based care and offers a wide range of digital tools to help members manage their health on the go.
- Humana Healthy Horizons in Oklahoma: Humana is known for its focus on wellness programs and incentives that reward members for completing healthy activities like annual screenings.
- Oklahoma Complete Health: This plan emphasizes local partnerships and integrated care, often providing robust support for behavioral health alongside physical health services.
Each of these companies has an established history in managed care. While they all cover the same essential services—like hospital stays, primary care visits, and prescriptions—the specific specialists and clinics available in their networks may vary.
Comparing Value-Added Benefits
One of the most significant advantages of the SoonerSelect program is the inclusion of value-added benefits. These are extra services provided by the MCOs at no additional cost to the member. When choosing a plan, comparing these extras is often the best way to decide which plan is right for you.
Common Extra Benefits
While specific offers can change, most plans include variations of the following benefits:
- Over-the-Counter (OTC) Allowances: Many plans provide a monthly or quarterly credit that you can use to buy health-related items like aspirin, vitamins, or bandages at participating pharmacies.
- Vision and Dental for Adults: Traditional Medicaid often limits dental and vision care for adults to emergencies only. Many SoonerSelect plans offer additional cleanings, exams, or credits toward eyeglasses.
- Wellness Rewards: You may be able to earn gift cards or other rewards for attending prenatal visits, getting your child’s vaccinations on time, or completing a health risk assessment.
- Transportation Assistance: Beyond standard medical transport, some plans offer expanded help with rides to grocery stores or community resource centers.
- Gym Memberships: Some plans partner with national fitness networks to provide free or discounted memberships to help members stay active.
Choosing Your Dental Plan
In addition to selecting a health plan, SoonerSelect members must also choose a dental plan provider. Just like the health plans, these dental providers manage your oral health benefits and offer their own sets of extra perks. The primary dental partners in Oklahoma are Liberty Dental and DentaQuest.
When selecting a dental plan, check if your current dentist is in the provider network. You should also look at the extra benefits offered, such as additional adult cleanings or oral health kits. If you do not choose a dental plan during your enrollment period, the state will automatically assign one to you, though you will have a limited window to change it later.
How to Enroll in a Plan
The enrollment process is designed to be straightforward. The Oklahoma Health Care Authority provides an online portal where you can compare plans and submit your choice. To enroll, you will typically need your SoonerCare member ID and basic personal information.
If you prefer not to use the online portal, you can also enroll by phone through the SoonerCare helpline. During the enrollment process, you will be asked to select one health plan and one dental plan. It is highly recommended that you check the “Find a Provider” tool on each plan’s website before making a final decision to ensure your preferred doctors and specialists are included.
What Happens if You Do Not Make a Choice?
If you are eligible for SoonerSelect but do not choose a plan by the deadline, the state will automatically assign one to you. This is known as “auto-assignment.” The state tries to match you with a plan that includes your previous doctors, but this is not always possible.
If you are auto-assigned to a plan and are not satisfied with it, you generally have 90 days from the start of your coverage to switch to a different plan. After that 90-day window, you will typically have to wait until the annual Open Enrollment period to make a change, unless you have a qualifying life event (such as moving to a new county where your plan isn’t available).
Tips for Making the Right Decision
To get the most out of your healthcare coverage, take a few minutes to evaluate your specific needs. Start by making a list of the doctors you see regularly and the prescriptions you take. Use the plan comparison tools to see which MCO covers your medications with the lowest hurdles and includes your doctors in their network.
Next, look at the lifestyle benefits. If you have young children, a plan with strong pediatric incentives and 24/7 nurse hotlines might be the priority. If you are focused on fitness, the plan offering the best gym access might be the winner. By taking an active role in this choice, you ensure that your healthcare works for your specific lifestyle.
Maintaining Your Coverage
Once you have selected your SoonerSelect plan, remember that you still need to complete your annual renewal for SoonerCare. The transition to managed care does not change the fact that you must prove eligibility to the state once a year. Keep your contact information updated with the Oklahoma Health Care Authority so you don’t miss important renewal notices.
SoonerSelect is a major step forward for Oklahoma’s healthcare system, offering more tools and resources than ever before. By choosing the plan that aligns with your needs, you can take full advantage of these new benefits and ensure a healthier future for yourself and your family. For more help with everyday transitions and navigating complex services, explore our other guides on managing public benefits and healthcare options.