Soon-To-Be-Sooners
Pregnancy-related care for
undocumented individuals
and non-citizens
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.
Program & Policy Overview
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
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)
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
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
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
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
Client Eligibility Verification
(OHCA Secured Website)
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
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
Contact Information
For policy questions and billing inquiries:
OHCA Provider Services
405-522-6205
1-800-522-0114 (toll free)