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Soon-To-Be-Sooners

The Oklahoma Health Care Authority is expanding pregnancy-related health care services for undocumented individuals and non-citizens through the Soon-To-Be-Sooners (STBS) program. Starting April 1, 2008, the program provides limited benefits for pregnancy-related care, including office visits, labs, hospital services, prescriptions, and more. Newborns born to program members will also be eligible for SoonerCare benefits for up to 12 months.

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Soon-To-Be-Sooners

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  1. Soon-To-Be-Sooners Pregnancy-related care for undocumented individuals and non-citizens

  2. Soon-To-Be-Sooners (STBS) The Oklahoma Health Care Authority (OHCA) is strongly committed to providing optimal health care as well as making improvements that may contribute toward positive birth outcomes in our state. We are pleased to announce that pregnancy-related health care services have been expanded for the benefit of babies who will be born citizens of Oklahoma and the United States through the “Soon-To-Be-Sooners” (STBS) program.

  3. Program begins April 1, 2008 Provides limited benefits for pregnancy-related care Available for undocumented or non-citizens who are pregnant Benefits for mother end at delivery Program & Policy Overview

  4. Program & Policy Overview continued… • Pregnant women may apply for benefits through OKDHS or out station centers • Applications may be downloaded at www.okhca.org • Members receive an OHCA medical ID card • Members are not eligible for Managed Care; excluded from SoonerCare Choice • Not eligible for STBS if found to have other insurance (TPL)

  5. Covered Services Benefits and covered services are those that impact the well-being of the pregnancy. For example: • Office visits that impact the pregnancy • Labs and some diagnostics related to the pregnancy • Hospital services for the birth • Hospital care for the newborn

  6. Covered Services continued… • Prescriptions for pregnancy related conditions as medically necessary • No prior authorization needed for prenatal vitamins • Prior Authorization needed for all other Rx’s • Genetic Counseling • Lactation Consultant services • Maternal and infant health social work services • Patient Advice Line

  7. Non-Covered Services • Dental services • SoonerRide • Vision (eye care) • Services for conditions that do not impact pregnancy outcome • Medical services for the mother after the birth of the baby • Exception--A postpartum visit is covered when provided as a component of the CPT billing code 59400

  8. Checking Eligibility • Providers will be able to check eligibility on this population as they would any other SoonerCare member • Eligibility Verification System (EVS) • OHCA’s Medicaid Secured Website

  9. Client Eligibility Verification (OHCA Secured Website)

  10. New Members • Upon eligibility of the program the mother will receive a “Welcome” letter to explain the program and who to call if she has any questions

  11. Newborn Member • Newborns are U.S. citizens and are eligible for the full scope of SoonerCare program benefits • Newborns will receive up to 12 months eligibility

  12. Contact Information For policy questions and billing inquiries: • OHCA Provider Services • 405-522-6205 • 1-800-522-0114 (toll free)

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