هيئة الرعاية الصحية في أوكلاهوما

SoonerCare is medical care delivered by OHCA as prescribed by the Social Security Act of 1965 (the Medicaid Act). The Federal Medicaid Act requires that certain medical services be delivered to recipients by hospitals and physicians. The State, however, is allowed to add other optional services, such as pharmacy services. With each of these programs, OHCA is responsible for setting compensation levels, services contained in each delivery system, contracts to deliver the services, and actuarial determinations regarding compensation. As of February 2012, those individuals covered by HCA comprise approximately 879,033 individuals across Oklahoma.^[1]

In order to be eligible to receive SoonerCare medical services from OHCA, an individual must meet any of the following requirements:

• Adults with children under 19
• Children under 19 and pregnant women
• Individuals 65 and older
• Individuals who are blind or who have disabilities
• Women under 65 in need of breast or cervical cancer treatment
• SoonerPlan – Men and women 19 and older with family planning needs

SoonerCare is a means tested program. State law provides that SoonerCare may cover individuals who have an annual income of equal to or less than 185% of the United States federal poverty level.^[2] OHCA contracts with Oklahoma Department of Human Services to determine eligibility for OHCA services. Additionally, OHCA actively works with the Office of the Oklahoma Attorney General's Medicaid Fraud Unit to prosecute fraudulent providers.

In September 2010, OHCA implemented an online system that uses an "enroll-first, verify-later" approach that automatically renews benefits for existing SoonerCare beneficiaries and enrolls new applicants if the system determines that they are likely to meet eligibility requirements. The program has streamlined enrollment processes, saving an estimated $1.5 million in operating costs and reducing the rate of those uninsured.^[3]

Insure Oklahoma is an employer sponsored insurance plan administered by OHCA which provides employers with premium subsidies to help buy health insurance for low to moderate income employees. Insure Oklahoma also provides a way for individuals who participate in the Individual Plan to gain access to an affordable health care option.

In April 2004, Senate Bill 1546 authorized the Oklahoma Health Care Authority to develop a program assisting employees of small businesses, 19 to 64 years of age with either:

• a portion of their private health plan premiums (Employer Sponsored Insurance), or
• شراء خطة صحية ترعاها الدولة وتعمل في إطار برنامج Medicaid الحكومي (خطة فردية).

في نوفمبر 2004، أنشأت مبادرة أوكلاهوما للرعاية الصحية آلية تمويل برنامج "تأمين أوكلاهوما". وقد زاد القرار رقم 713، الذي أُقرّ في استفتاء على مستوى الولاية، ضريبة المبيعات على منتجات التبغ. وخُصص جزء من هذه الإيرادات لتمويل البرنامج الصحي الجديد.