Oklahoma Health Care Authority

What Oklahoma Health Care Authority does

Oklahoma Health Care Authority (OHCA) is a state government agency established in 1995 and headquartered at 4345 N Lincoln Blvd, Oklahoma City. It serves as Oklahoma's designated Medicaid agency under the State of Oklahoma, administering the federal-state Medicaid program for the state. The agency operates SoonerCare, Oklahoma's core Medicaid program, which covers medical expenses for eligible low-income pregnant women, children, elderly individuals, people with disabilities, low-income parents, and women with breast or cervical cancer. OHCA also administers SoonerSelect (a comprehensive managed care program with contracted health and dental plans), Insure Oklahoma (employer-sponsored coverage), and OKSHINE (the state's health information exchange). Additional program modules include SoonerRide (non-emergency transportation), SoonerQuit (tobacco cessation), SoonerStart (early intervention for infants and toddlers with developmental delays), SoonerCare Dental, and SoonerCare Supplemental benefits.

The agency runs a platform-based Medicaid management operation with a Provider Portal for claims and patient management, and operates a network of enrolled healthcare providers statewide. Revenue is generated through federal-state Medicaid matching funds under the Federal Medical Assistance Percentage (FMAP) formula; the agency does not charge members directly, with eligibility determined by federal and state Medicaid regulations rather than market pricing. For fiscal year 2027, OHCA is projected to manage $872 million in Supplemental Hospital Offset Payment Program (SHOPP) directed payments to hospitals and $500 million in fee-for-service supplemental payments (up from $300 million). The agency serves approximately 1 in 4 Oklahomans and employs 251-500 people. Its core technology partner is Gainwell Technologies, which manages components of the Medicaid management information systems.

The business model is a government-administered, federally-matched Medicaid program with no commercial sales motion. Customer segments are defined by federal eligibility categories (pregnant women, children, elderly, disabled, low-income parents, and specific disease cohorts). Distribution is through online application portals, enrolled provider networks, and contracted managed care plans. The agency maintains community and tribal outreach channels to reach eligible populations, including Native American communities. Note that the firmographics field lists OHCA as "for_profit," but all evidence — including its parent being the State of Oklahoma, statutory designation as the state Medicaid agency, and tax-exempt government status — indicates it is a state government entity.

Name

Oklahoma Health Care Authority

Legal name

Oklahoma Health Care Authority

Website

https://okhca.org

Company type

Private

Founded year

1995

Operating status

Operating

Headcount range

251–500 employees

Short description

The Oklahoma Health Care Authority is Oklahoma's designated state Medicaid agency, administering the SoonerCare program and SoonerSelect managed care to provide healthcare coverage for approximately 1 in 4 Oklahomans, including low-income pregnant women, children, the elderly, and individuals with disabilities.

Ownership category

akta.pro rank

Product category

Government Health Care Administration

NAICS

Administration of Public Health Programs (923120)

SIC

Hospital & Medical Service Plans (6324)

akta.pro primary industry

Healthcare-Linked Social Benefits Administration (e.g., Medicaid/Means-Tested Health Coverage) (BPAIAKAH)

akta.pro secondary industries

Government Program Administrative Services (Medicare/Medicaid ASO/TPA) (HLAEALAO), Care Management & Population Health Program Administration (HLAEALAG)

Keywords

• Medicaid administration
• Health care coverage
• Managed care plans
• Health information exchange
• Medical transportation services

Headquarters

HQ city

Oklahoma City

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2C

Offering type

Services

Cost components

Operations, Personnel, Technology or R&D, Infrastructure, Supply Chain

Revenue model

1. State and Federal Medicaid Matching Funds: OHCA operates as a state Medicaid agency funded through federal-state matching funds. The federal government matches state Medicaid expenditures according to a formula (the Federal Medical Assistance Percentage, or FMAP). Oklahoma contributes state funds which are then matched by federal Medicaid funds, with the state expecting approximately $500 million in fee-for-service supplemental payments and managing $872 million in Supplemental Hospital Offset Payment Program (SHOPP) directed payments for fiscal year 2027.

Pricing tiers

Go-to-market motion1 record

Distribution channels3 records

Marketing channels3 records

Core offering

Oklahoma Health Care Authority (OHCA) is the state agency that administers Oklahoma's Medicaid program (SoonerCare), providing medical coverage to eligible low-income residents including pregnant women, children, elderly individuals, people with disabilities, low-income parents, and women with breast or cervical cancer. The agency also operates SoonerSelect managed care plans, Insure Oklahoma employer-sponsored coverage, OKSHINE health information exchange, and supporting services like SoonerRide transportation, SoonerQuit tobacco cessation, and SoonerStart early intervention.

Product overview

Oklahoma Health Care Authority operates a platform-based Medicaid management system comprising SoonerCare as the core Medicaid program, with SoonerSelect as a comprehensive health plan option, supported by OKSHINE for health information exchange. Additional offerings include Insure Oklahoma for employer-sponsored coverage, and specialized modules like SoonerRide for transportation, SoonerQuit for tobacco cessation, SoonerStart for early intervention, and SoonerCare Dental for dental benefits. The agency also provides a Provider Portal for healthcare providers to manage claims and patient information.

Differentiator

Problem solved

Functional benefit

Products and services

• SoonerCare Oklahoma's Medicaid program that pays for medical services for low-income pregnant women, children, individuals who are elderly or have a disability, parents and women with breast or cervical cancer. It is the core government health coverage program for eligible Oklahoma residents.
• SoonerSelect A comprehensive health plan option for SoonerCare members offering Choice Counseling, contracted health plans, dental plans, and children's specialty programs through managed care delivery.
• Insure Oklahoma A program that helps Oklahoma businesses provide health insurance coverage to their employees through carrier partnerships.
• OKSHINE Oklahoma's Health Information Exchange (HIE) that enables providers to access and share patient health information securely to improve care coordination.
• SoonerRide Non-emergency medical transportation service for SoonerCare members to access covered medical appointments.
• SoonerQuit Tobacco cessation program helping SoonerCare members quit tobacco through support and resources.
• SoonerStart Early intervention program for infants and toddlers with developmental delays or disabilities.
• SoonerCare Dental Dental benefits and services covered under the SoonerCare Medicaid program.
• Provider Portal Online portal for healthcare providers to manage claims, patient information, and administrative tasks related to SoonerCare.

Quantifiable outcome

• Serving approximately 1 in 4 Oklahoma residents
• +2 more outcomes

Segments6 records

Ideal customer profiles3 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Partnerships

One partnership is on record.

• Gainwell TechnologiescoreTechnology or IntegrationGainwell Technologies serves as a service provider to OHCA, handling aspects of the agency's data systems. A data security incident experienced by this service provider was publicly disclosed by OHCA, with substitute notice issued to affected individuals. The incident relates to Gainwell's role as a technology partner managing components of OHCA's Medicaid management information systems.

Scale indicators5 records

Recent moves6 records

Expansion highlights4 records

Regional players

• Texas Health and Human Services Commission: Administers Texas Medicaid and CHIP programs, serving as the designated single-state Medicaid agency for Texas. Operates a comparable mix of fee-for-service and managed care (STAR, STAR+PLUS) with similar regulatory monopoly structure to OHCA but in a much larger state.
• California Department of Health Care Services: California's single state Medicaid agency administering Medi-Cal, the largest state Medicaid program in the U.S. Operates a comparable FFS and managed care structure and faces similar federal compliance, consent decree, and program integrity obligations as OHCA.
• Florida Agency for Health Care Administration: Florida's designated Medicaid agency administering the Statewide Medicaid Managed Care program. Comparable to OHCA in operating a predominantly managed care delivery model with health plan contracting and member choice counseling.
• Arizona Health Care Cost Containment System (AHCCCS): Arizona's Medicaid agency, notable as the original statewide Medicaid managed care model. Operates a similar health plan contracting approach to OHCA's SoonerSelect and shares program integrity, federal compliance, and supplemental payment program functions.
• New York State Department of Health: New York's designated single-state Medicaid agency administering Medicaid Managed Care and mainstream FFS programs. Operates comparable waiver programs, supplemental payment pools, and consent decree structures analogous to OHCA's federal obligations.
• Ohio Department of Medicaid: Ohio's single state Medicaid agency administering managed care and FFS programs. Comparable to OHCA in operating Medicaid Managed Care through contracted health plans and administering similar supplemental payment programs for hospitals.

Broad incumbents

• Centers for Medicare & Medicaid Services (CMS): The federal agency within HHS that administers Medicare, partners with state Medicaid agencies, and sets the federal regulations and FMAP funding that OHCA operates under. CMS is the ultimate oversight body that OHCA reports to and is funded by.

Others

• Centene Corporation: The largest Medicaid managed care insurer in the U.S., a likely SoonerSelect contracted health plan partner for OHCA. Operates in adjacent space as an enabling partner that delivers care to OHCA's enrolled members under managed care contracts.
• Molina Healthcare: A leading Medicaid-focused managed care organization that frequently contracts with state Medicaid agencies including OHCA's peers. Operates in an enabling capacity as a contracted health plan under SoonerSelect-style arrangements.
• Gainwell Technologies: OHCA's actual technology vendor managing components of the Medicaid Management Information System (MMIS). Provides MMIS, claims processing, and eligibility systems to many state Medicaid agencies, making it both a vendor peer and a systemic dependency for OHCA's operations.

Market position

Strengths4 records

Weaknesses5 records

Competitive moat3 records

Key risks6 records

Key highlights6 records

Customer concentration

• Xx.com/oksoonercare
• Facebookfacebook.com/ok.soonercare
• LinkedInlinkedin.com/company/oklahoma-health-care-authority

Revenue estimate

Valuation estimate

Number of profiles

Profiles2 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Oklahoma Health Care Authority