Rosa sat across from her mother’s oncologist, medical bills piling up on the desk between them. “The doctor says Mom needs hospice,” she told the social worker, voice tight with worry. “But we’re on SoonerCare. We can’t afford private care. Can we even get hospice?”
The social worker smiled gently. “Rosa, SoonerCare covers hospice 100%. Every single service. No copays, no bills, no cost to you. Your mother will get the same excellent care as anyone else.”
Rosa’s eyes filled with tears—this time, tears of relief.
If you’re on SoonerCare (Oklahoma Medicaid) and wondering whether you or your loved one can access hospice care, the answer is a resounding yes. This guide will explain exactly what SoonerCare covers, how to qualify, and how to enroll in hospice with zero out-of-pocket costs.
Quick Answer: SoonerCare Covers Hospice 100%
Yes, hospice fully accepts SoonerCare (Oklahoma Medicaid). Hospice is a federally mandated Medicaid benefit, meaning every state—including Oklahoma—must cover hospice for Medicaid beneficiaries. SoonerCare covers all hospice services at 100% with no copays, no deductibles, and no out-of-pocket costs. This includes nursing care, medications, medical equipment, hospice aide services, social worker and chaplain support, and bereavement counseling. If you’re enrolled in SoonerCare and have a terminal illness with a six-month prognosis, you qualify for full hospice benefits at no cost.
Does Medicaid Cover Hospice? (Yes - Federal Requirement)
Let’s start with the foundation: Hospice is a required benefit under Medicaid.
Federal Medicaid Hospice Benefit
In 1982, Congress established the Medicare hospice benefit. At the same time, hospice became a mandatory benefit for state Medicaid programs.
What this means:
- ALL states must offer hospice coverage through their Medicaid programs
- States cannot opt out or limit hospice coverage
- Medicaid hospice benefits mirror Medicare hospice benefits (same services, same coverage)
Oklahoma’s responsibility:
Oklahoma administers Medicaid through the Oklahoma Health Care Authority (OHCA) as “SoonerCare.” By federal law, Oklahoma must cover hospice for eligible SoonerCare beneficiaries.
Result:
If you’re on SoonerCare and meet hospice medical eligibility criteria, you have the RIGHT to hospice care at no cost.
What is SoonerCare? (Oklahoma’s Medicaid Program)
Before diving into hospice coverage, let’s clarify what SoonerCare is.
SoonerCare Basics
SoonerCare is Oklahoma’s Medicaid program.
Administered by the Oklahoma Health Care Authority (OHCA), SoonerCare provides health coverage for:
- Low-income Oklahomans
- Children and pregnant women
- Elderly individuals (65+)
- Individuals with disabilities
- Nursing home residents
How many Oklahomans are on SoonerCare?
Over 900,000 Oklahomans (approximately 20% of the state’s population) receive SoonerCare benefits.
What SoonerCare covers:
- Doctor visits
- Hospital care
- Prescription medications
- Long-term care (nursing homes)
- Home health services
- Hospice care (our focus here)
- And many other medical services
Cost to beneficiaries:
Most SoonerCare benefits have no copays or very low copays. Hospice specifically has ZERO copays—completely free.
SoonerCare Hospice Benefits Explained: What’s Covered?
SoonerCare hospice coverage is comprehensive. Here’s exactly what you receive at no cost:
All Nursing Care (100% Covered, No Copays)
Registered Nurses (RNs) and Licensed Practical Nurses (LPNs):
- Skilled nursing visits 2-3 times per week (or more if needed)
- Assessment and management of symptoms (pain, nausea, breathing difficulty, etc.)
- Wound care for pressure sores or surgical wounds
- Medication management and education
- Family caregiver training
24/7 on-call nursing:
A hospice nurse is available by phone 24 hours a day, 7 days a week. Urgent visits available if symptoms require immediate attention.
Continuous care during crises:
If symptoms become severe (uncontrolled pain, severe breathing difficulty, agitation), hospice provides continuous nursing care at home (nurse stays with patient for hours or overnight). Covered 100%.
Hospice Physician Services
Hospice medical director:
A physician who specializes in hospice and palliative care oversees your care plan.
- Initial certification of hospice eligibility (six-month prognosis)
- Ongoing recertification every 60-90 days
- Medication orders and treatment plan oversight
- Available for family conferences and complex symptom management
Cost to you: $0
Your primary care physician can remain involved if you wish, but the hospice physician becomes the primary managing physician for your terminal illness.
All Medications Related to Terminal Illness (100% Covered)
SoonerCare covers ALL medications related to your terminal illness and symptom management:
Pain medications:
- Morphine, oxycodone, fentanyl patches, acetaminophen (Tylenol), etc.
Anti-anxiety medications:
- Lorazepam (Ativan), diazepam (Valium), alprazolam (Xanax)
Anti-nausea medications:
- Ondansetron (Zofran), prochlorperazine (Compazine), scopolamine patches
Breathing medications:
- Albuterol nebulizer treatments, morphine for dyspnea (breathlessness), oxygen (if needed)
Medications for secretions:
- Atropine drops, scopolamine patches (for “death rattle”)
Bowel medications:
- Laxatives (senna, docusate, MiraLAX, bisacodyl suppositories)
Any other comfort medications your hospice physician orders
No copays. No prior authorizations. No delays.
Hospice delivers medications directly to your home, usually within 24 hours of enrollment.
All Medical Equipment and Supplies (100% Covered)
Hospice provides any equipment you need for safe, comfortable care at home:
Hospital bed:
Electric hospital bed delivered and set up in your home. Allows positioning for comfort, reduces caregiver strain.
Mobility equipment:
- Wheelchair
- Walker
- Bedside commode
- Raised toilet seat
Oxygen equipment (if needed for comfort):
- Oxygen concentrator or tanks
- Tubing and cannulas
Medical supplies:
- Incontinence briefs and bed pads
- Wound care supplies
- Gloves, masks, hand sanitizer
- Nutritional supplements (if appropriate)
Comfort items:
- Pressure-relieving mattress or cushions
- Hospital-grade bed linens
Cost to you: $0. Hospice delivers, sets up, and maintains all equipment. When your loved one passes, hospice picks up equipment.
Hospice Aide Services (Personal Care)
Hospice aides provide personal care assistance:
- Bathing and showering
- Dressing and grooming
- Oral hygiene and mouth care
- Skin care
- Hair care
- Assistance with toileting
Frequency:
Typically 2-3 times per week (varies by hospice agency and patient needs).
Cost to you: $0
Hospice aides provide dignity, cleanliness, and respite for exhausted family caregivers.
Social Worker Services
Hospice social workers provide:
- Emotional support and counseling for patient and family
- Advance care planning assistance (living will, healthcare proxy, POLST)
- Resource connection (financial assistance programs, community resources, burial/cremation planning)
- Caregiver stress management and respite planning
- Crisis intervention
- Grief counseling for anticipatory grief (grief before death occurs)
Cost to you: $0
Chaplain Services (Spiritual Care)
Hospice chaplains offer:
- Spiritual support for patient and family (all faiths or no faith welcome)
- Prayer, scripture reading, rituals (if desired)
- Existential support (questions about meaning, purpose, suffering)
- Coordination with patient’s own clergy or faith community
- Support for family members struggling spiritually
Cost to you: $0
Note: Chaplain services are optional. You don’t have to be religious to receive hospice care.
Bereavement Counseling (13 Months After Death)
After your loved one passes, SoonerCare hospice provides bereavement support for the family:
- Grief counseling (individual or group)
- Support groups
- Educational materials about grief
- Check-in calls from bereavement coordinator
- Memorial services
Duration: Up to 13 months after death
Cost to you: $0
Respite Care (Up to 5 Days)
Family caregivers need breaks. SoonerCare covers respite care:
- Patient is admitted to a nursing home or inpatient hospice facility for up to 5 consecutive days
- Gives family caregivers time to rest, travel, or handle other responsibilities
- Available once per benefit period (can be repeated if needed)
Cost to you: $0
Inpatient Hospice Care (If Symptoms Can’t Be Managed at Home)
Most hospice care occurs at home, but if symptoms become severe and can’t be managed at home, SoonerCare covers inpatient hospice care:
- Admission to inpatient hospice unit or hospital for intensive symptom management
- Short-term stay (typically 3-5 days) to stabilize symptoms
- Goal: Return home once symptoms controlled
Cost to you: $0
What SoonerCare Hospice Does NOT Cover
To be clear, there are a few things SoonerCare hospice does not cover:
Room and Board (If in Nursing Home or Assisted Living)
If you live in a nursing home or assisted living facility and receive hospice there, SoonerCare hospice covers all the services listed above—but you still pay room and board (rent) for the facility.
However:
If you were already on SoonerCare nursing home coverage before enrolling in hospice, SoonerCare continues to cover your nursing home room and board through the regular SoonerCare nursing home benefit (separate from hospice benefit).
Curative Treatment for Terminal Illness
When you elect hospice, you agree to focus on comfort rather than curative treatment for your terminal illness.
What this means:
- Chemotherapy to cure cancer: NOT covered
- Surgery to remove tumors: NOT covered
- ICU hospitalizations to prolong life: NOT covered
- Dialysis (in most cases): NOT covered if used to prolong life, not for comfort
Important clarification:
You CAN receive treatment for other conditions unrelated to your terminal illness. For example:
- If you’re on hospice for cancer but break your arm, SoonerCare covers treatment for the broken arm
- If you have diabetes and heart disease unrelated to your hospice diagnosis, you continue diabetes and heart medications
Care Unrelated to Terminal Illness
SoonerCare hospice covers care related to your terminal illness and symptom management. It does not cover unrelated medical care—but regular SoonerCare benefits continue to cover those.
Eligibility for SoonerCare Hospice: Who Qualifies?
To receive SoonerCare hospice, you must meet TWO eligibility requirements:
Requirement 1: Be Enrolled in SoonerCare (Oklahoma Medicaid)
You must be an active SoonerCare beneficiary. If you’re not currently enrolled, you can apply (more on this below).
Requirement 2: Meet Hospice Medical Eligibility
Terminal illness with six-month prognosis:
A physician must certify that you have a terminal illness and, if the disease follows its expected course, a life expectancy of six months or less.
Conditions that commonly qualify:
- Advanced cancer
- End-stage heart failure
- End-stage COPD or lung disease
- End-stage kidney disease (not on dialysis, or choosing to stop dialysis)
- Advanced dementia (late stage Alzheimer’s, vascular dementia, Lewy Body dementia)
- End-stage liver disease
- Advanced Parkinson’s disease
- ALS (Lou Gehrig’s disease)
- Multiple other terminal conditions
Patient must elect hospice benefit:
You (or your healthcare proxy if you’re unable to decide) must choose to focus on comfort care rather than curative treatment. This is a voluntary choice, not forced.
SoonerCare Eligibility: Income and Asset Limits (2026)
If you’re already on SoonerCare, skip this section—you’re financially eligible. If you’re NOT currently on SoonerCare but need hospice, here’s how to qualify financially:
Aged, Blind, Disabled (ABD) SoonerCare Category
Most hospice patients qualify under the ABD category (elderly or disabled individuals).
Income limits (2026):
- Individual: Approximately $1,050-$1,200/month (check OHCA website for current figures)
- Couple: Approximately $1,400-$1,600/month
Asset limits:
- Individual: $2,000
- Couple: $3,000
Exempt assets (don’t count toward limit):
- Your home (primary residence)
- One vehicle
- Personal belongings, clothing, household items
- Burial plots and small burial funds
If You’re NOT on SoonerCare But Need Hospice
You can apply for SoonerCare:
Having a terminal illness qualifies you under the “disabled” category of ABD SoonerCare.
Hospice social worker can help:
Most hospice agencies have social workers who assist with SoonerCare applications. They know the process and can expedite enrollment.
Retroactive coverage possible:
In some cases, SoonerCare provides retroactive coverage for up to three months before application approval. This means hospice care provided while your application is pending may be covered.
SoonerCare vs. Medicare Hospice Coverage: What’s the Difference?
If you have both SoonerCare AND Medicare (called “dual eligible”), here’s what you need to know:
Similarities (Both Cover Hospice Fully)
- Same services covered
- Same $0 copay structure
- Same benefit periods (initial 90 days, then 60-day periods with recertification)
Minor Differences
Primary payer:
If you have both Medicare and SoonerCare, Medicare is primary (pays first) and SoonerCare is secondary (covers any gaps—though hospice has no gaps, so this is mostly irrelevant).
Documentation:
Medicare and SoonerCare may have slightly different documentation requirements, but the hospice agency handles this—not you.
Managed care organizations (MCOs):
SoonerCare uses managed care plans (like SoonerSelect). Some SoonerCare MCOs manage hospice directly; others “carve out” hospice to fee-for-service. This doesn’t affect your coverage—hospice is still 100% covered—but affects how the hospice agency bills.
Dual Eligible Oklahomans (Have BOTH SoonerCare AND Medicare)
What happens:
Medicare pays for your hospice care. SoonerCare acts as backup (secondary insurance) to cover any Medicare gaps—though Medicare hospice has no copays, so there are no gaps to cover.
Result: Still $0 cost to you. You receive full hospice benefits with zero out-of-pocket expenses.
How to Enroll in Hospice with SoonerCare: Step-by-Step
Enrolling in hospice with SoonerCare is straightforward. Here’s the process:
Step 1: Verify SoonerCare Enrollment
Check your SoonerCare card:
Make sure you have an active SoonerCare member card with your member ID.
If unsure, call OHCA:
Oklahoma Health Care Authority SoonerCare helpline: 1-800-987-7767
They can verify your enrollment status.
Step 2: Get a Hospice Referral (Helpful but Not Required)
Doctor referral (most common):
Your doctor (oncologist, cardiologist, primary care physician, neurologist) refers you to hospice. The doctor provides medical records documenting your terminal diagnosis and prognosis.
Self-referral (you can call hospice directly):
You do NOT need your doctor’s permission to request hospice. You can call a hospice agency yourself. The hospice agency will contact your doctor for medical records, but the doctor doesn’t have to agree to the referral.
Hospital or nursing home social worker:
If you’re in a hospital or nursing home, the social worker can arrange hospice referral.
Step 3: Choose a SoonerCare-Accepting Hospice Agency
Good news: Most Oklahoma hospice agencies accept SoonerCare.
How to verify:
When calling hospice agencies, ask: “Do you accept SoonerCare?”
The answer will almost always be yes.
How to find hospice agencies:
- Medicare.gov Hospice Compare tool (search by Oklahoma zip code, filters by Medicaid certification)
- Oklahoma Health Care Authority website (OHCA provider directory)
- Hospital or nursing home social worker referrals
- Ask your doctor for recommendations
Step 4: Hospice Evaluation (Free, No Obligation)
Once you contact a hospice agency:
A hospice nurse comes to your home (or visits you in the hospital/nursing home):
- Reviews your medical history and current condition
- Assesses symptoms and care needs
- Explains hospice services
- Determines whether you meet hospice eligibility criteria (six-month prognosis)
- Answers all your questions
This evaluation is FREE and involves NO OBLIGATION.
If you decide hospice isn’t right for you, there’s no charge and no pressure.
Step 5: Elect Hospice Benefit (If Eligible)
If you and the hospice team agree hospice is appropriate:
You sign an election form:
This form states you’re choosing hospice care (comfort focus) over curative treatment for your terminal illness.
SoonerCare hospice benefit begins immediately.
Step 6: Care Begins (Usually Within 24 Hours)
Equipment delivered:
Hospital bed, wheelchair, bedside commode—whatever you need—delivered and set up.
Medications delivered:
Comfort kit (emergency medications) and ongoing prescriptions delivered to your home.
Nurse visits start:
Your hospice nurse schedules regular visits (2-3 times per week initially).
24/7 support activated:
You receive a phone number for 24/7 on-call hospice nurse support.
Finding SoonerCare-Accepting Hospice Agencies in Oklahoma
Most Oklahoma hospice agencies accept SoonerCare, but here’s how to find them:
Medicare.gov Hospice Compare Tool
Website: medicare.gov/care-compare
How to use:
- Enter your Oklahoma zip code
- Select “Hospice” as the care type
- Filter results by “Accepts Medicaid” (all SoonerCare-certified agencies will appear)
- Review ratings, services, and contact information
Oklahoma Health Care Authority (OHCA) Provider Directory
Website: oklahoma.gov/ohca
OHCA maintains a directory of SoonerCare-participating providers, including hospice agencies.
Call Hospice Agencies Directly
What to ask:
- “Do you accept SoonerCare?”
- “Which SoonerCare managed care plans do you work with?” (important if you’re in a SoonerCare MCO)
- “Do you serve my area/county?”
Major Oklahoma Cities: Hospice Coverage
Tulsa area: Multiple hospice agencies serve Tulsa and surrounding counties
Oklahoma City metro: Numerous hospice agencies serve OKC, Edmond, Norman, and metro suburbs
Muskogee area: Hospice agencies serve Muskogee County and surrounding eastern Oklahoma
Rural Oklahoma: Hospice agencies serve all 77 Oklahoma counties. Even in remote rural areas, you can access hospice at home.
SoonerCare Managed Care Plans and Hospice
Oklahoma SoonerCare uses managed care organizations (MCOs) for most beneficiaries.
What Are SoonerCare MCOs?
Common SoonerCare MCOs:
- SoonerSelect (most common)
- Other plans depending on your county
MCOs are private insurance companies contracted by OHCA to manage SoonerCare benefits for members.
How MCOs Handle Hospice
“Carved out” vs. managed:
In some cases, hospice is “carved out”—meaning the MCO does NOT manage your hospice care. Instead, hospice is billed directly to OHCA fee-for-service.
In other cases, the MCO manages hospice benefits directly.
What this means for you:
Honestly, not much. Hospice is still covered 100% with no copays, regardless of whether it’s carved out or MCO-managed.
If you have a SoonerCare MCO:
- Check with your MCO about hospice procedures (call the member services number on your SoonerCare card)
- The hospice agency will handle prior authorizations if needed (not your responsibility)
- No extra cost to you
What If You’re NOT on SoonerCare But Need Hospice?
If you’re not currently enrolled in SoonerCare but need hospice, you have options:
Can You Apply for SoonerCare?
Yes. Having a terminal illness qualifies you under the Aged/Disabled category of SoonerCare.
How to apply:
- Online: mysoonercare.org
- By phone: 1-800-987-7767
- In person: Local OHCA offices (Tulsa, Oklahoma City, Muskogee, and other cities)
Hospice social worker can help:
Contact a hospice agency and explain your situation. Their social worker can assist with the SoonerCare application and expedite the process.
Retroactive coverage:
SoonerCare may provide retroactive coverage for up to three months before your application is approved. This means hospice services you receive while waiting for approval may be covered.
Other Coverage Options If You Don’t Qualify for SoonerCare
Medicare (if you’re 65+ or disabled):
Medicare Part A covers hospice fully. No SoonerCare needed.
Veterans benefits (if you’re a veteran):
VA provides hospice benefits for eligible veterans.
Private insurance:
Most private insurance plans cover hospice fully.
Charity care:
Most hospice agencies provide some free or reduced-cost care for uninsured patients who don’t qualify for any coverage programs. Contact hospice agencies and explain your situation—many will still serve you.
Financial barriers should NEVER prevent hospice care.
Hospice agencies work with families to find coverage options. Don’t assume you can’t afford hospice—reach out and ask for help.
Oklahoma SoonerCare Resources and Contact Information
Oklahoma Health Care Authority (OHCA)
Main website: oklahoma.gov/ohca
SoonerCare helpline: 1-800-987-7767
Hours: Monday-Friday, 8:00 AM - 5:00 PM Central Time
What they can help with:
- Verify SoonerCare enrollment
- Answer questions about hospice coverage
- Assist with SoonerCare applications
- Provide member services support
SoonerCare Eligibility and Application
Apply online: mysoonercare.org
Apply by phone: 1-800-987-7767
In-person assistance:
Local OHCA offices in major Oklahoma cities:
- Tulsa: 2140 S. Yale Ave, Tulsa, OK 74114
- Oklahoma City: 4545 N. Lincoln Blvd, Suite 124, Oklahoma City, OK 73105
- Muskogee: 2800 N. Main St, Muskogee, OK 74401
(Call ahead to confirm hours and services)
SoonerCare Member Services
If you have questions about your specific SoonerCare coverage:
Call: 1-800-987-7767
Ask: “I need information about hospice coverage under SoonerCare.”
SoonerCare Managed Care Plans
If you’re enrolled in a SoonerCare MCO (like SoonerSelect), contact your MCO directly:
Member services number: On the back of your SoonerCare member card
Ask about: Hospice benefits, network hospice providers, prior authorization (if required)
Frequently Asked Questions About SoonerCare Hospice
1. Does SoonerCare cover hospice in Oklahoma?
Yes. SoonerCare covers hospice 100% with no copays, no deductibles, and no out-of-pocket costs. Hospice is a federally mandated Medicaid benefit, so Oklahoma must provide full hospice coverage for SoonerCare beneficiaries.
2. What if I’m on SoonerCare AND Medicare?
If you have both (dual eligible), Medicare pays for hospice as the primary payer, and SoonerCare covers any gaps as secondary insurance. Since hospice has no copays under Medicare, there are no gaps to cover—but you’re still fully covered at $0 cost.
3. Do I need a doctor’s referral for SoonerCare hospice?
A doctor’s referral is helpful but NOT required. You can self-refer by calling a hospice agency directly. The hospice agency will contact your doctor for medical records, but you don’t need your doctor’s permission to request hospice.
4. Will SoonerCare pay for hospice at home?
Yes. Home hospice is the primary location for hospice care, and SoonerCare covers all home hospice services 100%. SoonerCare also covers hospice in nursing homes, assisted living facilities, and inpatient hospice units.
5. Are there any copays for SoonerCare hospice?
No. Zero copays for all hospice services, medications, equipment, and supplies. Completely free.
6. Can I choose any hospice agency with SoonerCare?
Yes, as long as the hospice agency is SoonerCare-certified (Medicaid-certified). Most Oklahoma hospice agencies accept SoonerCare. Verify by asking: “Do you accept SoonerCare?“
7. How long can I receive SoonerCare hospice?
As long as you remain terminally ill with a six-month prognosis. Hospice recertifies eligibility every 60 days after the initial periods (90 days, then 90 days, then 60-day periods). There is no time limit—if you continue to meet eligibility criteria, hospice continues.
8. What if I don’t qualify for SoonerCare financially?
If you have a terminal illness but your income/assets are too high for SoonerCare, you may still qualify for Medicare (if 65+ or disabled), Veterans benefits (if a veteran), or private insurance. Contact hospice agencies—many provide charity care for uninsured patients who don’t qualify for any program.
9. Will SoonerCare cover my hospice medications?
Yes. All medications related to your terminal illness and symptom management are covered 100% by SoonerCare hospice—no copays, no prior authorizations.
10. Does SoonerCare cover inpatient hospice care if I can’t stay home?
Yes. If symptoms become severe and can’t be managed at home, SoonerCare covers inpatient hospice care 100%—no copays, no cost to you.
Conclusion: SoonerCare Ensures Everyone Can Access Hospice
No one should suffer at the end of life because they can’t afford care.
Key Takeaways:
- SoonerCare covers hospice 100%—no copays, no bills, no financial barriers.
- Over 900,000 Oklahomans are eligible for SoonerCare hospice benefits.
- All services included: nursing, medications, equipment, hospice aides, social worker, chaplain, bereavement support.
- Easy enrollment: Verify SoonerCare, choose a hospice agency, complete evaluation, and care begins—often within 24 hours.
- Oklahoma has resources: OHCA helpline, local offices, hospice agencies throughout all 77 counties.
If you or your loved one is on SoonerCare and facing a terminal illness, you deserve comfort, dignity, and expert care. Hospice provides all of this at no cost to you.
Don’t let fear of costs prevent you from getting the care you need. Call a hospice agency today, verify they accept SoonerCare (they almost certainly do), and request a free evaluation.
You deserve compassionate, expert care. Hospice is here for you, and SoonerCare ensures you can access it without financial worry.
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