Oklahoma Medicaid Coverage under Soonercare
Soonercare is Oklahoma’s Medicaid health coverage program and is administered by the Oklahoma Health Care Authority (OHCA). Most children with autism in Oklahoma receive health care benefits through Soonercare.
Prior to 2019, Soonercare did not include coverage for medically necessary care of children with autism. This was in violation of a 2014 mandate by the Centers for Medicare and Medicaid Services (CMS) which stated that all state Medicaid plans must cover medically necessary care of children with autism. This mandate is in accordance with the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit of Medicaid which states that beneficiaries under the age of 21 are entitled to all health care services that are found to be medically necessary to treat conditions discovered in a child.
This year, the Oklahoma Health Care Authority (OHCA) officially amended the state Medicaid plan to cover medically necessary for autism, including ABA. Autism Speaks and advocates are working on the implementation and roll out of this coverage. We will provide updates to the community when coverage becomes effective.
In addition, to the rollout of the new autism benefits, there is ongoing work on recognizing Registered Behavior Technicians (RBTs) as ABA providers under OHCA administered health plans. The Oklahoma Department of Human Services recognized that RBTs must be recognized under the new ABA benefit, and the Governor recently signed the Department of Human Services rules recognizing RBTs as such. As a result, the OHCA is working to add RBTs to the state Medicaid plan and OHCA rules. This process has begun with the goal of the new policies going into effect January 1, 2020.
The Oklahoma Healthcare Authority recently published another proposed policy that clarifies that registered behavior technicians (RBTs) be included in the delivery of applied behavior analysis services.
Your public comment does not have to be long. We encourage you to express your support of this important addition of RBTs to the service delivery model of the new autism benefit. If you have any questions, please feel free to contact us at advocacy@autismspeaks.org.
For information on how to quality and apply for Soonercare, visit the OHCA website.
Last Updated: November 2019