| Group |
Income Eligibility |
| Children |
185% FPL |
| Pregnant Women |
185% FPL |
| Parents |
36% FPL |
| Adults (Working for a Small Employer) |
185% FPL |
| SSI Disabled (non-elderly) |
74% FPL |
Medicaid, SCHIP, and Federal Authority2
HIFA Waiver - On September 30, 2005, CMS approved the Oklahoma Premium Assistance Plan under the HIFA initiative. The Oklahoma Health Care Authority submitted the waiver seeking to cover an additional 50,000 residents of the State of Oklahoma with incomes at or below 185 percent FPL in the Oklahoma Employer/Employee Partnership for Insurance Coverage (O-EPIC).
The increased coverage will be funded by state general fund revenues generated by a tobacco tax, along with federal matching funds under Title XIX and employer and employee contributions. O-EPIC premium assistance has two different strategies for covering low-wage workers. The Employer Sponsored Insurance program helps low-wage workers in small firms purchase qualified insurance offered by their employer. The Individual Plan will help qualified individuals get health insurance coverage even if they are not able to get coverage through their employer.
Eligible Employer Sponsored Insurance program populations include adults who work for small employers and have incomes above the Medicaid standard, but no more than 185 percent FPL and their spouses. O-EPIC began enrollment in November 2005 and as of November 2006, 1,200 people were enrolled (650 firms).
Eligible Individual Plan populations include self-employed, unemployed currently seeking work, workers who are not eligible to participate in their employer's small group health plan, and workers (and their spouses) whose employers do not offer a group health plan and have incomes above the Medicaid standard but no more than 185 percent FPL. The working disabled who have incomes above the Medicaid standard, but no more than 200 percent FPL are also eligible for the Individual Plan. Enrollment will begin in 2007.
To learn more about the O-EPIC program, read SCI's Profile in Coverage.
To learn more about the Oklahoma HIFA Waiver, read SCI's HIFA Waiver Comparison Chart.
High-Risk Pool
The Oklahoma Health Insurance High Risk Pool became operational in 1996. The pool is financed by premiums and assessments to the insurers. The premium cap is set at 150 percent of the average premium rate charged. As of June 2006, 2,600 persons were enrolled in the pool.
Information presented in the profile was summarized in December 2006 from a review of state Web sites and reports, and through contacts with state officials. In most cases the profiles were reviewed by state officials; however, it is possible that states have implemented strategies that are not reflected in this profile. |
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| 1 This overview provides a general description of state coverage levels under their Medicaid and SCHIP programs, including coverage through waivers, as of October 2006. Health Management Associates researched eligibility information from state web sites, data from state reports, and verified through contacts with state officials during the fall of 2006. This does not reflect the specific eligibility categories or requirements. This is not intended to be a substitute for eligibility information provided by each state. Individuals interested in applying for these programs should contact the state directly for specific eligibility requirements. |
2 The profile only includes Medicaid and SCHIP waivers intended to make comprehensive expansions to the uninsured. At this time, the profiles do not include Family Planning, Pharmacy Plus waivers, or long-term care waivers. |
3 Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau's March 2005 and 2006 Current Population Survey. |
4 Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends. 2004 Medical Expenditure Panel Survey-Insurance Component.
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