Forms and Resources

FORMS

Authorization to release Medicaid records
Open Records Request Form
Out of Pocket Expense Claim Reimbursement Form
Self-Employment/Cash Income Statement - English
Self-Employment/Cash Income Statement - Spanish

RESOURCES

Accredited Colleges
ESI Online Enrollment Guide – Digital
Income Fact Sheet (MAGI)
Income Guidelines
Insure Oklahoma Rules
Out of Pocket Expense Policy

Last Modified on Oct 16, 2024

Oklahoma Health Care Authority

4345 N Lincoln Blvd

Oklahoma City, OK 73105

Public Notices
Nondiscrimination Notice
Language Assistance
Employee E-Mail Access
Legal Notices
Report Suspected Medicaid Fraud

The Oklahoma Health Care Authority collects the personally identifiable data submitted and received in regard to applications for services, renewals, appeals, provision of health care and processing of claims. This data is treated as confidential and is stored securely in accordance with applicable law and regulations. OHCA may share this personally identifiable data with its authorized business associates, government agencies with jurisdiction over the OHCA, or as otherwise required or permitted by applicable law.