Who qualifies for SoonerCare in Oklahoma?

SoonerCare is Oklahoma’s Medicaid program. Adults 19 to 64 may qualify under Medicaid expansion if household income is at or below 138% of the federal poverty level, and other groups may qualify based on age, disability, pregnancy, or caregiving status. The Oklahoma Health Care Authority keeps current eligibility and income charts and an online application in the MySoonerCare portal.

What addiction treatment SoonerCare typically covers

SoonerCare covers a continuum of substance use disorder services when medically necessary. This includes outpatient behavioral health services like assessment and psychotherapy, partial hospitalization programs for adults, medication assisted treatment for opioid use disorder at opioid treatment programs and office based settings, medically supervised detoxification, and residential SUD treatment when ASAM criteria are met. Coverage details and medical necessity rules are set in the OHCA policy manual.

Residential treatment specifics

Residential SUD is covered at defined ASAM levels when a member has a qualifying SUD diagnosis and meets residential level of care through the state’s designated ASAM tool. Covered levels include 3.1, 3.3, and 3.5, with program staffing, service hours, and documentation requirements spelled out in policy revised September 1, 2025. The rule also references withdrawal management and links to the prior authorization manual used in Oklahoma.

Partial hospitalization and intensive outpatient style care

For adults, SoonerCare recognizes partial hospitalization as an intensive, structured nonresidential program that can be an alternative to or step down from inpatient or residential. Provider accreditation and program standards are defined in OHCA policy and related provider provisions.

Medication assisted treatment, including methadone

SoonerCare covers medically necessary MAT, including methadone in certified opioid treatment programs, with required counseling supports. MAT can also be provided in office based opioid treatment settings by contracted providers. The OTP section details phases of care and documentation expectations.

SoonerSelect plans and networks

Since April 1, 2024, many members get benefits through SoonerSelect health plans. All plans must cover the same core SoonerCare services, and each plan has its own provider network. Members choose among Aetna Better Health of Oklahoma, Humana Healthy Horizons of Oklahoma, and Oklahoma Complete Health. Always confirm that the treatment program is in network for the member’s plan.

How to verify your benefits before admission

Start with the MySoonerCare member portal to confirm eligibility, view benefits, and find providers. If you need help, call the SoonerCare helpline at 800-987-7767. If you are enrolled in SoonerSelect, have your plan ID card ready and call your plan for network confirmation and any prior authorization steps the plan requires. Great Plains Recovery Center’s admissions team can also verify benefits directly with OHCA or the SoonerSelect plan once you share your member ID and date of birth.

Documents to have ready

To avoid delays when a plan asks for verification, bring or upload items the OHCA Document Verification Guide lists as acceptable: proof of identity, proof of Oklahoma residency, Social Security number, and proof of income when requested. Also bring your SoonerCare or SoonerSelect plan ID, a list of current medications, and any discharge or referral paperwork from recent care.

Transportation to treatment

SoonerCare offers non-emergency medical transportation through SoonerRide. Members can schedule rides at no cost for medically necessary appointments by calling 877-404-4500. Plans advise booking at least 3 business days in advance, and SoonerSelect partners with Modivcare to coordinate rides.

Important limits to know

Benefits must be medically necessary, some services require prior authorization, and coverage details can change. Always check the current SoonerCare Benefits page and the specific OHCA policy sections that apply to the service you need.

Get help today

If you or a loved one needs help now, call Great Plains Recovery Center admissions. We can verify SoonerCare or SoonerSelect coverage, confirm network status, and walk you through arrival and what to bring so you can start safely and quickly.