SoonerCare Choice/Insure Oklahoma Waiver

The waiver was implemented in 1996 following approval by the Centers for Medicare & Medicaid Services and is currently approved through Dec. 31, 2025. This authority has allowed OHCA to expand health care services to members and providers through the development of SoonerCare Choice and Insure Oklahoma. Other beneficial programs including the patient-centered medical home, health management program, Health Access Network pilot program and the SoonerExcel incentive payment program have also been established under the waiver.

Additionally, the SoonerCare Choice/Insure Oklahoma waiver has allowed the state to extend eligibility to include individuals that would not otherwise qualify for coverage including:

Adults and full-time college students eligible for Insure Oklahoma with a household income up to 200% FPL
Children of parents covered by Insure Oklahoma

Please visit OHCA's SoonerCare Choice or Insure Oklahoma websites for more information on qualifications and benefits.

OHCA and CMS negotiate and agree upon special terms and conditions (often referred to as “the waiver”) which includes:

The SoonerCare section 1115 demonstration was initially approved by the Centers for Medicare & Medicaid Services (CMS) in 1995. The demonstration is currently approved for a five-year renewal period beginning Jan. 1, 2027 through Dec. 31, 2031.

The demonstration allows the Oklahoma Health Care Authority (OHCA) to operate several programs and authorities, including the Insure Oklahoma Employer-Sponsored Insurance program, Health Access Networks and the Health Management Program. The demonstration also includes certain waiver authorities applicable to SoonerCare populations, including a waiver of retroactive eligibility for specified populations.

Please visit OHCA’s SoonerCare Choice or Insure Oklahoma websites for additional information about program eligibility and benefits.

OHCA and CMS negotiate and agree upon waiver and expenditure authorities and Special Terms and Conditions (STCs), which define the scope of the demonstration and the state’s responsibilities.

CMS Approval Letter

On Aug. 28, 2026, CMS approved Oklahoma’s five-year renewal of the SoonerCare section 1115 demonstration, Project Number 11-W-00048/6, effective Jan. 1, 2027 through Dec. 31, 2031.

2026 SoonerCare 1115 Demonstration Approval Letter

Waiver Authority

The waiver authority identifies provisions of federal Medicaid law that CMS has waived to allow Oklahoma to operate specified components of the SoonerCare demonstration.

2026 SoonerCare 1115 Demonstration Waiver Authority

Expenditure Authority

The expenditure authority identifies expenditures that are not otherwise matchable under the Medicaid State Plan but may receive federal matching funds under the demonstration. These authorities include expenditures related to the Insure Oklahoma Employer-Sponsored Insurance population, Health Access Networks and the Health Management Program.

2026 SoonerCare 1115 Demonstration Expenditure Authority

Special Terms and Conditions

The Special Terms and Conditions establish the requirements governing Oklahoma’s operation of the demonstration, including eligibility, benefits and cost sharing, delivery systems, monitoring and reporting, evaluation, financial requirements and budget neutrality.

2026 SoonerCare 1115 Demonstration Special Terms and Conditions

CMS also posts approved section 1115 demonstrations, amendments, extensions and renewals on Medicaid.gov.

OHCA is required to submit to CMS one Annual Monitoring Report each demonstration year (DY) that is due no later than 180 calendar days following the end of the DY.

SoonerCare Choice Annual Reports

Budget neutrality workbooks are submitted to CMS separate from annual/semiannual reports. To locate any attachments submitted with each report, including the budget neutrality workbook, download the file, open in a PDF reader, and click the paperclip at the top left.

SoonerCare Choice Semi-Annual Reports

Budget neutrality workbooks are submitted to CMS separate from Annual/Semi-Annual reports. To locate any attachments submitted with each report, including the budget neutrality workbook, download the file, open in a PDF reader, and click the paperclip at the top left.

Evaluation Design and Reports

Click here to view the CMS-approved Evaluation Designs and Reports.

Last Modified on Sep 03, 2026