Summertime Update – 2025 Oklahoma Medicaid Medicare
Private medical offices and groups are the backbone of our health care system, providing essential ongoing care for their patients, not to mention the livelihood for thousands across the state. 2025 has come with a lot of changes to Oklahoma Medicaid & Medicare systems. The Berkeley Associates team is diligently working for our providers credentialing needs, while staying abreast of the changes in legislation and regulations. Our goal is that you are never caught unaware of important changes and pitfalls. 2025 has brought its share of them, to say the least.
Please look for ongoing updates, as together we weather these changes over the next year or so.
America was not built on fear. America was built on courage, on imagination, and an unbeatable determination to do the job at hand.
Harry S. Truman
Federal Medicaid Changes
“One Big Beautiful Bill” passed in July 2025, bringing major shifts:
- Work & Activity Requirements: Adults 19–64 must work/volunteer/study ≥80 hrs/month to stay eligible.
- Co-Pays: Up to $35 per visit for recipients above 100% FPL. (Federal Poverty Level)
- Asset Limits: Home equity over $1M makes applicants ineligible.
- Retroactive Coverage: Reduced from 3 months to just 1 month.
Impact for Providers:
- Anticipate more uninsured patients.
- Prepare for eligibility verification questions.
- Increased uncompensated care is likely.
Medicare Reimbursement Increases (2026)
- +3.8% Payment Bump for Advanced APM participants.( Alternative Payor Methods)
- +2.4% Outpatient Department Increase.
- Site-neutral payments to reduce cost discrepancies.
- Inpatient-only list phasing out.
Action Tip: Consider joining an APM to qualify for bonuses and streamlined reporting.
Part D Drug Plan Updates
- $2,000 Cap on annual out-of-pocket drug costs.
- Monthly Payment Option (“smoothing”) introduced.
- $35 Insulin Cap continues.
Provider Role: Educate patients during visits to help them understand cost-saving changes.
Medicare Advantage & Part C/D Changes
- Adjusted risk models and capitation rates for 2026.
- New network adequacy rules for behavioral health.
- Expanded dual-eligible enrollment pathways.
Provider Action Checklist |
|
|---|---|
| Medicaid | Prepare for patient eligibility shifts; update intake protocols |
| Medicare | Review your APM participation options |
| Part D | Help patients take advantage of caps and smoothing payments |
| MA/Part C/D | Coordinate with plans for behavioral health coverage |
| WC/MSAs | Confirm settlement documentation is compliant |
Reviewing Your Payer Strategy? Contact our team for assistance navigating summer 2025 policy changes.
Contract Renewal Required for All OHCA-Contracted APRNs by November 30, 2025
This is an important reminder for all Advanced Practice Registered Nurses (APRNs) currently contracted with the Oklahoma Healthcare Authority (OHCA):
- Your OHCA provider contract must be renewed by November 30, 2025.
- To assist with this process, OKHCA will send email reminder letters directly to providers no later than September 15, 2025
- Ensure your contact information is up to date with OHCA to receive all necessary communications and avoid any disruptions in participation or payment.
- We recommend beginning the renewal process as soon as possible upon receipt of your notice.
Need Help?
Our team is ready to assist you with the renewal process. Contact us if you have questions or need support.
Don’t delay – renewals are mandatory and time-sensitive!
Thank you,
Your Credentialing & Contracting Support Team
Oklahoma Medicaid Renewal Alert – Action Required!
ATTENTION PROVIDERS:
Oklahoma Medicaid (SoonerCare) will begin sending renewal notices in early September to all groups holding an active Oklahoma Medicaid number.
What You Need to Know:
- Each individual location (Group NPI + service location) must complete a separate renewal. Renewals are not automatic – action is required.
- Renewal notices will be sent to the mailing address or contact on file.
What You Should Do:
- Watch for your renewal notice in early September.
- Be prepared to complete the renewal process promptly to avoid disruption in participation or payment delays.
- Verify and update your current enrollment information, including addresses and contacts, with SoonerCare now.
Need Help?
Our team is ready to assist you with the renewal process. Contact us if you have questions or need support.
Don’t delay – renewals are mandatory and time-sensitive!
