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Oklahoma SoonerCareMedicaid · Coverage · Medical Policy · OK · Endocrinology, Urology, Plastic Surgery +2 moreHigh impact

Provider Letter 2026-11: Re: Immediate Medicaid Coverage Change; Senate Bill 904 (2026)

Act
immediately
Effective date
Jun 4, 2026
Identified
Jun 20, 2026

Summary

Oklahoma Medicaid immediately prohibits coverage of surgical procedures and pharmaceuticals for gender transition under Senate Bill 904. Claims with gender dysphoria diagnoses will suspend for review, and prior authorization is now required for specific hormone therapies.

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What to do

immediately · 4 steps
01For Oklahoma Medicaid patients with gender dysphoria diagnoses, billing team must submit additional documentation supporting medical necessity with all procedure claims to avoid automatic suspension.
02For pharmaceutical billing, obtain prior authorization for all male patients requesting female hormones, all GnRH prescriptions, and testosterone products.
03Contact massunit@okhca.org for questions.
04Claims without proper documentation or prior auth will be denied or suspended for MAU review.

Original notice

Provider Letter 2026-11: Re: Immediate Medicaid Coverage Change; Senate Bill 904 (2026)
oklahoma.gov · Always check the source before changing claims.
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Oklahoma SoonerCare policiesOK policy changesEndocrinologyUrologyPlastic SurgeryPsychiatryOB-GYN

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