Finding Medicaid Waivers in Oklahoma

The 20th more extensive and most populated state, Oklahoma has a long history in the Union that became the United States. Named from the Choctaw words okla and humma, which mean red people, Okies enjoy their state’s position as a major producer of natural gas, oil, and agricultural products, relying their economics on aviation energy, telecommunications, and biotechnology, setting their rank in 2007 as the fastest growing economies in the nation.

Along with their growing economics, Oklahoma has also experienced a growth in their population, such as their elderly population. As of 2013, the elderly population has gone to 14.3%, up from the 14.1% of the total US population. With this growth, the state has made sure that this population has access to affordable services, thanks to some of their Medicare waivers.

Oklahoma residents are covered by the SoonerCare program, which is the name for the Oklahoma Medicaid programs. Funded by both the federal and state governments, the program helps to pay some or all of the medical bills for those who are unable to afford them. To qualify for the program, participants need to live in Oklahoma, be a US citizen or a qualified alien, and meet the financial income for certain categories.

Many of these are grouped under the Home and Community Based Services waiver or HCBS; these waivers relate to integrated care for many elderly individuals and those who are 21 and over with physical disabilities.

Advantage

The Advantage waiver is for frail elderly individuals with physical disabilities, providing home and community based waiver services. Individuals that are eligible for Medicaid and have a need for nursing facilities are able to stay in their homes or in a residential setting of their choice. The services available include case management, advantage personal care, advanced supportive/restorative, skilled nursing/home health, adult day care, home delivered meals, in home respite and extended respite, hospice, and more.

To be eligible for this waiver, individuals need to qualify for SoonerCare, be 65 years of age or disabled adults as determined by the social security administration, be determined to meet the nursing facility level of care, not have a diagnosis or a mental retardation or cognitive impairment, and reside in their own home or that of a family member.

Medically Fragile

The Medically Fragile program is an alternative to being placed in a hospital or a skilled nursing unit. The goal is to provide Medicaid eligible services for those who would like to remain at home or in a residential setting of their choosing, while still receiving care. Medically fragile is defined as a condition that is chronic, resulting in prolonged dependency on daily medical care, usually characterized as a life threatening conditions that are acutely exacerbated and require frequent medical supervision, frequent administration of specialized treatment, or dependent on medical technology that is needed in order to maintain a reasonable level of health.

To be eligible for this waiver, participants needs to be at least 19 years of age, meet the requirements for hospital and/or skilled nursing care, meet the SoonerCare financial eligibility requirements, and must be living at home or a residential setting.

Sooner Seniors

A recently added program that began in 2011, the Sooner Seniors waiver is for individuals 65 and older who have long term illnesses and meet nursing facility level care. Individuals will need to complete a year in the Living Choice program a program for those who have resided in either a nursing facility, intermediate care facility, etc. and would like to transition back into the community.

Eligibility requirements for Sooner Seniors include being transitioned to the community through the Living Choice program, be 65 years or older and with a long term illness, meet the nursing facility level of care, and meet the financial requirements for SoonerCare.

My Life My Choice

The My Life My Choice program is another that is based on the Living Choice option allowing those who are in nursing facilities to transition out into the community. Also recently added as of 2010, the program offers the ability for those between the ages of 19 and 64 with physical disabilities to transition back into the community.

To be eligible for this program, individuals need to be between 19 and 64 years of age and have a physical disability, have been transitioned into the community through the Living Choice program, meet nursing facility level of care, and meet the SoonerCare financial eligibility.

For both of these programs Sooner Seniors and My Life My Choice the cost of the nursing facility must cost more than the program, a sign that the program is significantly more cost effective for the individual than if they were to stay within the nursing facility.

These are just some of the different programs Oklahoma residents and their families can look into if searching for assistance in terms of Medicaid or assisted living facilities. To learn more about these and other programs, individuals or families can contact the Oklahoma Heath Care Authority (OHCA), located in the Lincoln Center in the state’s capitol. You can reach them by phone at either the toll free number of 800.522.0310 or 405.522.7171 for those in the Oklahoma City area.

Learn More

For those who are members, the OHCA can be reached at 800.987.7767, with option 2 for online applications, renewals, and questions and option 6 for questions on SoonerCare.

Further Information

• SoonerCare
• Advantage Waiver Program
• Application for 1915 HCBS Waiver
• Medically Fragile
• Sooner Seniors
• Living Choice
• My Choice; My Life