126,000 Oklahomans could lose SoonerCare under new federal work requirements

OKLAHOMA, U.S. –

A new federal law will require many adults enrolled in SoonerCare to prove they are working, attending school, or performing community service in order to keep their health insurance coverage — and the Oklahoma Health Care Authority estimates up to 126,000 Oklahomans could be affected.

The requirement applies to adults ages 19 to 64 who receive Medicaid through Oklahoma’s expansion program. To maintain coverage, recipients will need to document at least 80 hours per month of work or another approved activity. States must verify each recipient’s eligibility at least every six months. Some affected members will receive preliminary informational notices from OHCA by the end of June to prepare them for the full rollout in January 2027.

Approved activities include working a paid job, attending school, participating in job training, and volunteering. However, healthcare providers say the logistics of proving any of those activities — particularly for people without reliable transportation, childcare, or regular schedules — remain a major unresolved concern.

The law also includes a lengthy list of exemptions. Recipients may be able to maintain their coverage without meeting the work requirement if they fall into one of the following categories:

• Pregnant or postpartum individuals (within 12 months of delivery)
• Parents, guardians, or caregivers of a child aged 13 or younger (parents of children 14 or older must still meet work requirements), or of a disabled individual
• People who are medically frail, disabled, or have a serious mental illness
• Veterans with a total service-connected disability rating
• Current or former foster youth under age 26
• Enrolled members of a federally recognized tribe eligible for Indian Health Services
• People who are currently incarcerated or were released within the past three months
• Individuals enrolled in a qualifying substance use disorder treatment program
• People in areas with unemployment rates above 8% or 1.5 times the national rate (pending federal approval)

Even if a recipient qualifies for an exemption, providers warn they will likely still need to verify that status through OHCA — a process whose details have not yet been finalized.

Susan Savage, CEO of Morton Comprehensive Health Services — a Tulsa-based health center serving a large Medicaid population — says her organization is already working to prepare patients, but without clear guidance from the state, that preparation has real limits.

“Part of what we’re talking about internally is how do we communicate the process to our patients who we know are on Medicaid now,” Savage said.

She expressed concern that the burden of documentation will fall hardest on people who are already working but lack the resources to prove it — pointing to barriers like irregular work schedules, lack of childcare, and limited transportation.

“It has been really just a period of time where if you are poor, you’re being penalized,” Savage said.

Savage also raised a longer-term concern about what happens to the healthcare system if large numbers of people lose coverage. She argued that people without insurance are less likely to seek primary care and more likely to delay treatment until a crisis forces them to the emergency room, which is far more costly.

“I think we are trying to reduce costs, and we are doing that in a way that ultimately will drive costs — because hospitals are going to see people don’t have insurance, they will be less inclined to come to primary care,” she said.

The Oklahoma Health Care Authority, which administers SoonerCare and will be responsible for verifying compliance under the new rules, provided a statement to News On 6:

“The Oklahoma Health Care Authority has been actively preparing for the implementation of work requirements and is committed to ensuring a smooth transition for the SoonerCare members impacted by this rule. We will continue to monitor federal guidance, work closely with CMS and keep our providers and partners informed as we move forward.”

The agency did not detail how affected members would be notified ahead of the end-of-June deadline or explain how the reporting and verification process will work in practice.

Savage says the technical systems required to verify work activity are not yet fully in place.

Arkansas is one of a few states to have previously implemented Medicaid work requirements. It did so briefly between June 2018 and March 2019, under the first Trump administration, before a federal judge struck the program down. Now that Congress has passed the requirement into law, there is no legal challenge available to stop it.

More than 18,000 people — roughly one in four subject to the requirement — lost coverage in the policy’s first seven months. Studies found that more than 95% of those who lost coverage appeared to already meet the work requirement or qualify for an exemption. Most lost coverage not because they weren’t working, but because they didn’t know they were required to prove it.

Among Arkansans ages 30 to 49 who lost Medicaid during that period, 50% reported serious problems paying medical debt, 56% delayed care because of cost, and 64% reported other negative health consequences. Research also found that work requirements did not increase employment over 18 months of follow-up — a central argument made by supporters of the policy.

According to the Center on Budget and Policy Priorities, roughly two-thirds of non-elderly adults on Medicaid are already working. Most of those who are not are either disabled or have caregiving responsibilities that make employment difficult or impossible.

Rep. Kevin Hern voted in favor of the legislation and framed the work requirements as a necessary step toward accountability and protecting the program’s long-term integrity, saying in a statement:

“The waste, fraud, and abuse of taxpayer dollars in federal assistance programs has gone unchecked for far too long, threatening resources for those most in need,” Hern said in a statement. “By including sensible work and community engagement requirements for able-bodied adults without young children, while ensuring exemptions for vulnerable populations, The Working Families Tax Cuts took an important step toward restoring accountability and protecting the integrity of the program for Oklahomans who truly depend on it.”

Savage pushed back on the fraud and abuse framing, noting Morton has received nine consecutive years of clean audits and maintains a rigorous internal eligibility verification process. She said the organization turns away patients who don’t meet income and eligibility requirements rather than accepting unverified Medicaid claims.

With details still being finalized, providers say SoonerCare recipients should take a few steps immediately:

• Make sure your contact information is current with OHCA: Notifications will be sent to the address and phone number on file. Missing a notice could start a clock toward losing coverage.
• Watch for notices in the mail before the end of June: OHCA says some affected members will receive information in the coming weeks.
• Identify whether you may qualify for an exemption — and be prepared to verify it. Qualifying does not automatically remove the documentation burden.
• Start keeping records of your work, school, or volunteer activity now: Pay stubs, school enrollment letters, or volunteer confirmation — so you’re prepared when reporting begins.
• Contact a Medicaid enrollment navigator: Organizations like Morton Comprehensive Health Services help SoonerCare patients navigate eligibility. Reach out before your status changes.

To reach the Oklahoma Health Care Authority directly with questions about SoonerCare eligibility, call 1-800-987-7767.