Two Weeks to Six: SoonerCare Payment Delays Put Oklahoma ABA Providers Under Pressure

A Two-Week Cycle Stretched to Six

OKLAHOMA CITY – SoonerCare, Oklahoma’s Medicaid program, used to reimburse Aligning Hope in about two weeks. The Edmond-based ABA practice, where Naomi Noel is a board-certified behavior analyst, is now waiting six weeks, and her colleagues have waited longer, Noel told KOKH-TV, the Fox affiliate in Oklahoma City, in a story published September 8.

“It really is gonna interrupt access to care for some of Oklahoma’s most vulnerable population,” Noel said.

She traced the problem to the governor’s office rather than claims processing. The delay, she said, is not tied to how claims are processed; it stems from “an executive order that went out from the governor last year that actually put the entire credentialing and contracting department behind.” She was referring to a July 2025 order directing the Oklahoma Health Care Authority (OHCA), which runs SoonerCare, to review its provider credentialing standards. She asked OHCA for “proactive communication about what perhaps they’re working on internally to speed up this process,” and suggested separating routine paperwork from more complex credentialing files.

Her forecast for smaller practices was blunt. She expects services to be paused, and if the pause runs long, “some of our smaller ABA providers are going to shut their doors or limit the number of SoonerCare clients that they’re willing to serve at one time,” she said.

OHCA did not dispute the delays. In a statement to the station, the agency said it “recognizes the challenges and frustrations many providers have experienced during the contracting process,” that “addressing the current contracting workload is OHCA’s top priority,” and that it has committed “additional staff, temporary resources, volunteers, technology enhancements and close collaboration with our managed care plans” to increase processing capacity. “We also recognize that contracting delays may have affected provider payments,” the statement said. “OHCA is formalizing a process to backdate payments, when appropriate, for providers adversely affected by extended contracting delays.” Details on eligibility and next steps will follow “as the process is finalized,” it said.

The remedy points to the problem. Backdated pay matters only if a practice cannot collect for sessions delivered while a staff member’s contract or renewal sits in the state’s queue. OHCA did not elaborate.

SoonerCare covered about 534,000 children under 21 in July 2026, roughly half of its 1.04 million members, according to OHCA’s monthly enrollment report. The agency’s enrollment and behavioral health reports do not break out how many of those children receive ABA.

“I anticipate that services will have to be paused and if they have to be paused for too long, I unfortunately anticipate that some of our smaller ABA providers are going to shut their doors or limit the number of SoonerCare clients that they’re willing to serve at one time.” – Naomi Noel, BCBA, Aligning Hope, to KOKH-TV (September 2026)

How the Backlog Built

The order Noel described is Executive Order 2025-16, which Gov. Kevin Stitt signed on July 31, 2025. It was about abortion, not autism therapy. The order told OHCA to make sure no SoonerCare provider was involved in abortions barred under state law, and it required every provider in the program to sign a form attesting to that. “We won’t allow tax dollars to indirectly subsidize and flow into the abortion industry under the guise of women’s health,” Stitt said in announcing it.

Every provider meant every provider, “regardless of their service scope,” OHCA told them: hospitals, physicians, pharmacies, therapists, and each ABA technician who holds a SoonerCare contract. About 34,000 had signed by January. The forms ran through the same OHCA office that approves and renews provider contracts.

The rollout was messy. OHCA’s own board balked at the rule needed to enforce the order, tabling it in September 2025 and voting it down in November, with members questioning whether the governor had the authority to impose it. Two days after that vote, OHCA put the requirement on hold. In January, Stitt reissued the order with revised wording, and OHCA started over: a new form, a new May 15 deadline, and a fresh round of filings from everyone who had not signed the first one.

The contract office was already behind. In November, OHCA extended expiring provider contracts to buy processing time. In January it did so again, and its February newsletter explained that “due to the high volume of renewals, processing is taking longer than usual.” By March, State Medicaid Director Melissa Miller told an agency advisory committee that the contracts staff were working through 14,000 renewals, the draft minutes show.

“Provider contracts staff are currently working on 14,000 contract renewals but hope that changes to staff and processes will help streamline workflow.” – OHCA Medical Advisory Committee draft minutes, March 5, 2026, recording State Medicaid Director Melissa Miller

OHCA has since pushed contract deadlines back twice more, most recently to December 31, 2026. Those extensions apply to providers whose existing contracts are expiring. They do not help a new hire waiting on a first contract.

In July, the agency dropped the standalone attestation and said it would check compliance with the order during routine contract renewals instead. The letter announcing the change gave no reason. A Senate bill to block the attestation had died in committee months earlier.

Noel is the only person on the record blaming the order for the backlog. OHCA’s statement to KOKH attributed the workload to “significant workforce pressures while implementing new state and federal requirements and responding to increased workload,” without naming the order. Its provider newsletters this year have cited a “high volume of renewals.”

Why ABA Practices Are So Exposed

Oklahoma’s rules make ABA unusually dependent on that one office. Every person who delivers ABA to a SoonerCare child, from the supervising BCBA down to each registered behavior technician (RBT), must hold their own contract with OHCA. The practice bills for a technician’s hours, but only a contracted technician’s hours are payable. Under those rules, every new technician a practice hires is another application in the state’s queue.

The requirement is recent. OHCA added it in 2024, in the same rule package that created the quality reviews now getting underway.

Managed care offers no way around it. Most SoonerCare members are in SoonerSelect, where private insurers (Aetna Better Health, Humana Healthy Horizons and Oklahoma Complete Health) pay the claims. But those plans cannot finish signing up a provider until OHCA issues its provider ID, and they cannot backdate that step, OHCA told providers in January. The state contract is the gate either way.

New Leadership, Fewer Staff

The backlog has landed on an agency in the middle of a leadership change and a political fight. Attorney General Gentner Drummond has spent the year criticizing OHCA over how its managed care insurers handle claims, and in April he asked the state auditor to investigate. “Providers across this state have been sounding the alarm for months,” he said. Stitt called the request “political theater.” That dispute is about the insurers, not the contract office, and Drummond’s public statements have not addressed the backlog.

OHCA’s chief executive, Clay Bullard, resigned in July after nine months in the job. Stitt named Aaron Morris, the state’s chief financial officer and a former OHCA finance chief, as interim director. Weeks earlier, the agency’s board had approved a budget that closed a $66 million gap with carry-forward cash and administrative cuts, including a smaller headcount and no staff bonuses. “Every person in the agency that works here felt a cut because of this process,” Bullard said in June. Ten weeks later, OHCA told KOKH it was adding staff to the contracting office.

What to Watch

OHCA’s board meets September 16, its first meeting since the review letter and the leadership change. The full implementation of Service Quality Reviews begins this month; OHCA says it will contact each provider before its review date. The latest contract extension runs to December 31, when OHCA must have cleared the August batch of renewals or extend them yet again.

As for the backdated payments from OHCA, the agency says details on who qualifies will come “as the process is finalized.” Not really a rock-solid promise. As of September 9, it had published nothing further. The September 16 board meeting the public and providers hope to hear.

AT A GLANCE

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