What do the new Oklahoma SoonerCare work requirements mean for members?

The Oklahoma Health Care Authority is notifying some SoonerCare members about new federal work requirements that take effect Jan. 1, 2027.

OHCA sent yellow letters Aug. 31 to SoonerCare expansion adults ages 19-64 who will likely have to meet the requirements unless an exception applies.

• Oklahoma SoonerCare work requirements begin Jan. 1, 2027, for expansion adults ages 19-64 who are not otherwise exempt.
• OHCA sent yellow letters Aug. 31 to SoonerCare members who will likely have to meet the new requirements unless an exception applies.

The requirements apply to SoonerCare expansion adults ages 19-64 who are not otherwise exempt.

The new federal requirements are part of changes to Medicaid eligibility under federal law. States must begin applying the community engagement requirements Jan. 1, 2027, unless they implement them sooner.

OHCA lists several exemptions, including certain pregnant and postpartum women, parents or caretakers of young children or people with disabilities, some people with health conditions, certain veterans, American Indian and Alaska Native individuals, and others.

Members who are subject to the requirements generally must meet one of several qualifying conditions.

They can:

• Work at least 80 hours in a month.
• Complete at least 80 hours of qualifying community service.
• Participate in a qualifying work program for at least 80 hours.
• Participate in an educational program at least half-time.
• Combine qualifying work, community service, a work program, or education for at least 80 hours.
• Earn at least $580 in monthly income.

Seasonal workers can also qualify by averaging at least $580 in monthly income over the previous six months.

• OHCA first reviews information it already has to determine whether a member meets the requirement or qualifies for an exception.
• If OHCA cannot verify compliance or an exception, the agency sends a notice explaining what information or documents are needed.
• Members must submit the requested information by the deadline listed in the notice.
• OHCA says members have 30 days to demonstrate compliance after an initial adverse determination.
• After that, OHCA will check compliance or exemptions when members renew, generally every six months.

Members should make sure their phone number, mailing address, and email address are current with SoonerCare. OHCA also advises members to watch their mail and email for additional letters or instructions.

Members who receive a yellow letter should read it carefully and follow any instructions and deadlines included in the notice.

Qualifying activities can include employment, structured community service, certain work programs, and education. For volunteer work to count, OHCA says it must be unpaid work that benefits the community and be conducted through a structured program managed by a public or nonprofit organization.

A yellow letter does not necessarily mean a member will ultimately lose SoonerCare.

OHCA says it will first use information already available to determine whether a person meets the requirements or qualifies for an exception. If additional information is needed, the agency will send the instructions about what documents must be submitted.

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