Oklahoma Medicaid pays for in-home personal care and related services through 3 programs, including the ADvantage Waiver and the In-Home Supports Waiver (Adults and Children). OKDHS Community Living, Aging and Protective Services operates ADvantage and SPPC; OKDHS Developmental Disabilities Services operates the DD waivers; OHCA is the Medicaid agency. Oklahoma uses an open EVV model, and claims without data from an OHCA-approved system are not paid. Confirm with OHCA whether these services are carved out of SoonerSelect managed care.
Yes. State Plan Personal Care (SPPC) serves SoonerCare members from children through aging adults who meet level of care, with a personal care attendant for personal care, meals, housekeeping, laundry and shopping, plus nurse care planning.
Which Oklahoma waivers can a home care agency bill?
Each waiver below lists who it covers, the services it pays for, and how providers bill.
ADvantage Waiver
Population
SoonerCare-eligible adults 65 or older, or 19-64 with a physical disability (or a developmental disability without intellectual disability), who meet nursing facility level of care and need a waiver service at least monthly.
Services covered
personal care
respite
advanced supportive and/or restorative assistance
adult day health care
home-delivered meals
personal emergency response system
case management
nursing
Consumer Directed Personal Assistance Services and Supports (CD-PASS)
Billing format
EVV check-in and check-out generates the claim, which the provider approves and submits electronically to OHCA; data must come from an OHCA-approved EVV system or aggregator (OAC 317:30-3-34).
Oklahoma residents with an intellectual disability who meet SoonerCare financial eligibility; the adult waiver is for ages 18 and older and the children's waiver for ages 3-17.
To bill Medicaid for home care you need a state license, a Type 2 NPI, state Medicaid enrollment and screening, waiver or managed care contracts, EVV and authorizations.
Private pay means higher rates and fast payment; Medicaid means steady volume at state-set rates with authorizations and EVV. Compare rates, cash timing and admin before you mix them.
Track units remaining, the end date and the service code for every client, and check them before each schedule change. Hours over the cap are unbillable.
Four units equal one hour. How to convert units to hours, the common HCPCS codes, how states round partial units, and how to stay inside the authorization.
These free tools are made by the team behind Caregiver Scheduling,
caregiver scheduling software for home care agencies.
Simple pricing
From$199/month
Up to 10 caregivers on Starter, 50 on Growth.
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