SoonerCare Member Memo - Fall 2019

Member Memo

Fall 2019

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Agency Closures

Close up of calendar displaying Martin Luther King, Jr. Day

OHCA offices will be closed on the following dates:

  • Nov. 28-29 – Thanksgiving
  • Dec. 24-25 - Christmas

We will be happy to assist you during our regular business hours.

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Reminder: Out-of-State Care Changes

Beginning Sept. 1 the Oklahoma Health Care Authority’s policies for out-of-state services changed. These changes ensure members have access to quality care while controlling program costs. The policy changes do not impact routine medical care for SoonerCare members.

These revisions clearly define coverage and reimbursement for services performed by providers who are physically located outside of Oklahoma.

What SoonerCare Members Need to Know:

  • Members who live near the Oklahoma state border who regularly see a provider contracted with SoonerCare will see no changes, as long as the provider is contracted with OHCA and their office is within 50 miles of the Oklahoma border.
  • Emergency care in another state is still eligible for reimbursement if the care is determined to have been medically necessary and emergent.
  • Self-referrals are no longer permitted and members are responsible for medical costs if they do not receive the proper authorization for out-of-state services. Members who think they need out-of-state services should talk to their primary care provider.
  • Single-case agreements and contracts are not allowed under the new rule changes. SoonerCare members who were receiving out-of-state services through single-case agreements will be switched to regularly-contracted SoonerCare providers that OHCA medical staff have determined can provide the same level of care at OHCA’s regularly contracted rates.

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Flu Prevention

Doctor injects vaccination in female patient

It is officially flu season! The flu is different from a cold since it usually comes on suddenly. People infected with flu may infect others before symptoms develop and up to seven days after symptoms appear. Young children may infect others even longer than seven days after they start showing symptoms.


The most important step to protect yourself and others from getting the flu, is to get a flu vaccination. Flu vaccination is recommended for everyone 6 months and older. It is important to get vaccinated every year. It is especially important for young children and children with certain long-term health problems. Caregivers of children should also get a flu vaccine.

In addition to getting vaccinated, other ways to prevent the spread of the flu virus include:

  • Staying away from people who are sick.
  • If you are sick, avoid contact with others.
  • Cover your coughs and sneezes.
  • Wash your hands often.
  • Avoid touching your eyes, nose and mouth.
  • Clean surfaces or objects that may have been touched by an infected person.

Respiratory Syncytial Virus

Respiratory syncytial virus, also known as RSV, is a common respiratory illness for children that occurs during the late fall and continues into the spring. Anyone can get RSV, but this seasonal infection is most commonly found in children less than 2 years of age. RSV can be spread through contact with other infected individuals, objects or surfaces.

RSV symptoms are similar to symptoms of the common cold such as fever, runny nose, cough, sore throat, chills, aching and fatigue. High-risk individuals with RSV may have more severe symptoms, including wheezing, shortness of breath and even developing pneumonia.

During RSV season, babies who were born early are considered high-risk for developing complications if they get RSV. These infants are often prescribed a monthly treatment of an antibody called Synagis during the five months of RSV season to help reduce their risk. If you think your child may be high-risk, ask your doctor if Synagis may be a good option for treatment.

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Has Your Child Been to the Dentist During the Last Six Months?

During a routine dental visit, your child’s dentist may perform a cavities risk assessment. SoonerCare members ages 20 and under are eligible for dental cleanings twice per calendar year and a cavities risk assessment once per calendar year.

Benefits of cavities risk assessments include:

  1. Prevent cavities or lesions before they appear.
  2. Help patients understand possible risk factors that could lead to diseases.
  3. Determine how often a patient should seek preventive and restorative treatment.
  4. Monitor the patient’s treatment.

For more information, speak with your child’s dental home provider.

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Prior Authorization No Longer Required for Some Medication Assisted Treatment Products

Pharmacist and customer intently discuss prescription at pharmacy counter.

SoonerCare has made policy changes to substance use treatment products, also known as medication assisted treatment. Prior authorization is no longer required on preferred products. These products include Suboxone (buprenorphine/naloxone SL films) (brand preferred) and buprenorphine/naloxone SL tablets (generic only). Additionally, beginning Jan. 1, 2020, all medication assisted treatment products will not have a copay for members. The new copay amount applies to all members. Non-preferred products still require prior authorization.

If you have questions regarding your medication assisted treatment, please contact your provider or the pharmacy helpdesk at 800-522-0114, option 4.

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Changes in Household Circumstances

mother sitting with her two kids

Did you know changes in household circumstances can impact your SoonerCare eligibility?

These changes can include:

  • Returned mail/insufficient Oklahoma address on file.
  • Moving/change of address.
  • Earned or unearned income.
  • Number of people in your household.

If you may have had a change in household circumstance, please contact the SoonerCare Helpline at 800-987-7767 to update your information today.

If you enrolled through the Department of Human Services, please contact your DHS caseworker to update to your information.

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Our vision is for Oklahomans to be healthy and to have access to quality health care services regardless of their ability to pay.

OHCA Core Values:
Inclusiveness | Accountability | Engagement | Innovation | Integrity


The Oklahoma Health Care Authority does not discriminate on the basis of race, color, national origin, sex, religion, age or disability in employment or the provision of services.

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