Medicaid Adult Expansion SPAs: Eligibility, Alternative Benefit Plan, & FMAP Claiming

The proposed Title XIX SPAs listed below were submitted to CMS to request the following:

  • OK SPA 20-0024 adds adults 19-64 years of age, as per Section 435.119 of Title 42 of the Code of Federal Regulations, as a new eligibility group in the SoonerCare Program.
  • OK SPA 20-0023 establishes alternative benefit plan (ABP) for individuals in the adult group.
  • OK SPA 20-0025 establishes eligibility procedures for identification of the adult group for purposes of securing the Federal Medical Assistance Percentage (FMAP) rate for the adult group.

Please view the draft SPA pages here: OK SPA 20-0024, OK SPA 20-0023, and OK SPA 20-0025 and submit feedback via the comment box below.

Tribal Consultation: 02/21/20

14-day Tribal Consultation Period: 02/21/20 – 03/06/20

Circulation Date: 02/21/20

Requested Effective Date: 07/01/20   



Will Marshallese Americans, who are exempt from Medicaid (OAC 317:35-5-25.d(6)), be included in the waiver?
OHCA Staff Reply
Mandatory and optional State Plan groups within the section 1115 demonstration waiver derive their eligibility through the Medicaid State Plan, and are subject to all applicable Medicaid laws and regulations in accordance with the Medicaid State Plan, except as expressly waived in the demonstration. Under current law, Marshall Islanders are not eligible for federal public benefits (except emergency services and programs expressly listed, such as Medicaid for emergency medical care).

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Please note that all comments must be reviewed and approved prior to posting. Approved comments will be posted Monday through Friday between the hours of 7:30 a.m. – 4 p.m. Any comments received after 4 p.m. will be posted on the following business day.