The Oklahoma managed care landscape is dominated by Tulsa-headquartered Blue Cross and Blue Shield of Oklahoma and national players UnitedHealth Group and Aetna. Local HMO CommunityCare is also a significant player in the Tulsa market, where it is owned by the market's two Catholic health systems, Saint Francis Health System and St. John Health System. The state is expanding Medicaid and selected managed care plans to administer the program. As the nation struggled with the Omicron wave the COVID-19 restrictions became more stringent, thus leading to a decline in the commercial enrollment (Clarivate data). Additionally, many residents lost their employer coverage due to the pandemic, off-exchange commercial enrollment decreased, while the more insurers decided to join the exchange marketplace (like Ambetter and Friday Health Plans) or expanded options (Centene expanding its Medicare Advantage plans in Oklahoma) could see some uptake for 2022.