In September 2010, the Oklahoma Health Care Authority (OHCA) implemented the first real-time online enrollment system for Medicaid and the Children’s Health Insurance Program (CHIP). Oklahoma’s system functions as an online application and uses a sophisticated rules engine that provides an eligibility determination instantly. Almost three-fourths (72 percent) of applicants are eligible to use the online enrollment system to apply for Medicaid and CHIP coverage, known as SoonerCare in Oklahoma. This report summarizes findings from a case study analyzing Oklahoma’s real-time online enrollment system, conducted as part of a larger study evaluating Express Lane Eligibility (ELE) and alternative simplifications that might help identify, enroll, and retain children eligible for Medicaid and CHIP coverage.