When we elect someone to public office, should we expect them to use their best judgment in making decisions about the public interest? Or should they adhere to the dictates of outside groups that always take the most simplistic and extreme stance on their particular issue, regardless of the context for Oklahomans? And when politicians sign a pledge sponsored by a special interest, should that give the interest veto power over the legislators’ judgment?

A couple of recent events have put these questions into dramatic relief. The first concerns a hospital provider fee, which would be assessed on participating hospitals and matched with federal dollars to pay for treating Medicaid recipients. Hospitals support the fee, since the match would generate another $223 million beyond the $153 million they pay into it, and the combined funds would then return to the hospitals as reimbursements for patient care. Read the rest of this entry »

Jeffrey Alderman, M.D., is an associate professor in the Department of Internal Medicine at the University of Oklahoma School of Community Medicine in Tulsa.

With Medicaid cuts looming and the federal government entertaining efforts to shift the costs of Medicare and Medicaid on to states and individuals, the future of health care reform and reimbursement seems murkier now than ever. But gaining little attention is the issue of physician workforce. In other words – with the size and scope of our health care provider pool now shrinking, how will we meet increasing patient demand with our current available workforce?

Despite our best efforts, we simply cannot attract new physicians to the state, and a large percentage of our OU/OSU graduates leave to work outside of Oklahoma. This helps to explain why in 2009 the Commonwealth Fund ranked Oklahoma 50^th in the nation for health status and health system performance. Similarly, a 2007 American Medical Association report found that Oklahoma ranks last in the US in physicians per capita, perhaps revealing why there is a 14-year difference in life expectancy between some north and south Tulsa communities. Read the rest of this entry »

The U.S. House or Representatives is expected to vote tomorrow on a federal budget proposal for the coming year that would —  among other things —  force drastic cuts to Medicaid that would harm Oklahoma seniors, people with disabilities, and children.  The budget plan, introduced by Republican Congressman Paul Ryan of Wisconsin, would also shift costs and risks onto our state and likely would force the state to cut payments to hospitals, nursing homes, physicians, and pharmacies.

Medicaid  is a primary source of health insurance for seniors, persons with disabilities, and children. Medicaid is especially important for Oklahomans receiving long-term care  in their homes or in nursing home facilities. It is also a cornerstone of the health care system for hospitals, physicians, pharmacies, nursing care facilities, home health care providers, and other professionals and businesses across the state. About one out of every five Oklahomans – close to 700,000 people -  receive health insurance coverage through Medicaid.

The Ryan proposal would turn Medicaid into a block grant.  Instead of covering a fixed share of a state’s Medicaid costs, the federal government would write a check each year. It would dramatically cut the amount of money it gives to a state, and that cut will grow bigger and bigger every year.  In total, states would receive $771 billion less over the next ten years under the Ryan plan; Oklahoma would lose some $8.2 billion, according to projections from Families USA. Read the rest of this entry »

Another budget year, the same sad story: The combination of tax cuts and the recession results in severe cuts to public services.

Over the past two years, most agencies have lost 15 percent or more of their funding. Even though state appropriations as a share of the economy is at a 30 year low, next year’s shortfall is projected at $500 million. The Governor’s proposed budget for next year would eliminate some agencies and take another 3 to 5 percent from the rest.

Last year we surveyed some of what’s been lost. Here’s an update:

• With personnel costs making up 93 percent of its budget, more cuts to the Public Safety Department will mean furloughs and possibly laying off troopers. The Department already has 110 fewer employees than 2 years ago, and more than half of the drivers’ license testing sites across the state have been closed. A portion of these funds are being replaced by increasing the fee to reinstate a driver’s license. Read the rest of this entry »

The ‘Oklahoma Health Insurance Exchange’ will begin serving as an online marketplace for individual and small group consumers to buy private insurance in 2014.  Online insurance exchanges – which we discussed in this recent blog post -  are one of the primary requirements of the Affordable Care Act passed by Congress last year. News from the governor’s office that the state has accepted a $54 million dollar ‘early innovator’ grant from the federal government means that Oklahoma is now poised to build the most advanced insurance exchange in the country.

Why was Oklahoma one of only six states selected for this grant?  There are two programs that uniquely position Oklahoma as an innovator of health care information technology:  Insure Oklahoma (IO) and SoonerCare online enrollment (OE).  Online enrollment for SoonerCare, the state’s Medicaid program, went live in September 2010 and has already dramatically improved the efficiency of the application process.  Applicants input required information on family members, income, etc. into a web-based interface, and their eligibility is determined in real-time (subject to verification). Three months after online enrollment launched, only 7 percent of SoonerCare applications were paper.  OK Policy blogged about the launch of online enrollment and the resulting national accolades this past December. Read the rest of this entry »

Donna Rhodes is the CEO of the Long Term Care Authority, a public trust authority of the city and county of Tulsa leading the Tulsa community and the state in addressing long term care reform.

While the voice of long term care has been mostly silent in the health care reform discussion, it is unlikely to remain that way for much longer.  This sleeping giant has been extensively studied and analyzed, producing a multitude of recommendations both nationally and locally.  Yet without serious effort to strategically plan and implement the necessary infrastructure changes, states will be caught unprepared for the impact of long term care’s growing cost and will miss out on the expected federal incentives for supporting long term care systems change.

Shifting more financing for long term care from institutional care to home and community based services (HCBS) has been a policy goal across the nation since the 1970s.  Oklahoma’s initial investment in “balancing” the state’s long term care financing and service delivery systems changes began in earnest with the creation of a local public trust authority focused exclusively on long term supports and services and, subsequently, the establishment of a statewide comprehensive HCBS system.  The ADvantage HCBS Program, operated and managed by private business located across the state, was intended to become the foundation on which to build a Medicaid managed long term care system for the predicted “tsunami” of long term care needs of an aging population with chronic illnesses and disabilities. Read the rest of this entry »

Michael Fogarty, Chief Executive Office of the Oklahoma Health Care Authority, will be speaking on “The Economics of Health Care Reform” at noon on Thursday, January 20, 2011 at the Oklahoma History Center. The talk is the first spring lecture of the Practice and Policy Lecture Series co-sponsored by the Oklahoma Department of Human Services and the University of Oklahoma Center for Public Management. The event is free and open to the public, with lunch available for purchase.

Fogarty has been CEO of the Oklahoma Health Care Authority since 1999. The agency administers the Oklahoma SoonerCare (Medicaid) programs with a staff of more than 430 employees. As CEO of the Health Care Authority, his statutory duties include service on several agency boards including the University Hospitals Authority and Trust, the Oklahoma Commission on Children and Youth and the O.S.U. Medical Authority.

Fogarty previously served as the Health Care Authority’s State Medicaid Director and Chief Operating Officer. His career includes stints at the Oklahoma Department of Human Services as the Deputy Director and Assistant Director for Medical Services. He was a member of the Washington D.C. legislative staff of former U.S. Senator David Boren. Fogarty’s career also included private law practice and private health-related business.

In 2005, Fogarty was named Administrator of the Year by the Oklahoma Chapter of the American Society for Public Administration. The award is given annually to a public servant in Oklahoma whose career exhibits “the highest standards of excellence, dedication, and accomplishment.”

For additional information and for the full list of lectures in the series, click here.

“Is there anyone here from Oklahoma?”

I was at a national conference of health care policy experts and advocates last month when the morning’s plenary speaker, Cindy Mann, Medicaid Director for the Centers for Medicare and Medicaid Services, posed that ominous question. “Uh-oh. What have we done this time?”, I wondered, as I tentatively lifted my hand.  But this time, Oklahoma was being singled out for major praise, not ridicule. What Oklahoma had done that had Mann and several others at the conference gushing was launch a new streamlined enrollment system for the Medicaid program that may be the most user-friendly in the nation – and that positions Oklahoma at the front of the pack as states face the challenges and opportunities of implementing health care reform in the coming years.

Until the launch of the new enrollment system, applicants for SoonerCare health insurance coverage, the state’s Medicaid program, submitted a paper application to the Oklahoma Department of Human Services (DHS) during regular office working hours. In most cases an eligibility determination would be made 20 to 30 days later after information was entered into the agency’s legacy mainframe computer and verified. Policies and procedures were handled at least slightly differently in each county office and by each caseworker, and the client numbering and tracking system was prone to errors. Read the rest of this entry »

An front-page USA Today article last week reported that government anti-poverty programs – including Medicaid health insurance coverage, food stamps, unemployment benefits and welfare cash assistance – are now assisting one in six Americans and are continuing to expand.  Anyone who has been following the monthly releases of our Numbers You Need bulletin is unlikely to be surprised by the trends reported by USA Today.  Oklahoma continues to see ongoing growth and record caseloads for Medicaid (just under 695,000 recipients) and food stamps (over 585,000), with fewer individuals receiving cash payments for unemployment benefits (weekly average of 36,000 initial and continuing claims) and TANF (21,640).

It so happened that USA Today published its report the day before the Oklahoma Asset Building Coalition held the first of five regional meetings around the state. These gathering are bringing together a diverse group of stakeholders to talk about  challenges facing low- and moderate-income Oklahomans and strategies for achieving economic security. The meeting began with a presentation on the Oklahoma Self-Sufficiency Standard, a tool for calculating the amount of income that families of different sizes and compositions need to meet their basic household expenses – housing, food, child care, transportation, health care, taxes and miscellaneous – without public or private support or subsidies. For a single working adult with one infant and one preschool child, the hourly self-sufficiency wage is $16.43 an hour in Cherokee County and over $21.63 an hour in Tulsa County. For a two-parent family with kids that age, each working adult would need to make $10.28 an hour in Cherokee County and $12.39 an hour in Tulsa to meet its basic needs. It’s worth mentioning that this is a basic family budget with an austere set of assumptions – it includes no meals out or entertainment, no one-time purchases, no loan payments or money put aside for savings. Read the rest of this entry »

Today we released the 19th issue of our monthly Numbers You Need bulletin, which tracks monthly and quarterly data for key economic indicators. As in many recent months, the overall economic news was mixed: a slight increase in employment and rebound in state revenues, offset by continued high numbers of bankruptcy filings. But while we have seen  fluctuations in many indicators of the state’s economic well-being over the course of the economic downturn,  one constant has been an increasing number of Oklahomans turning to public programs for assistance with food and medical care. In March, participation in the Supplemental Nutrition Assistance Program (formerly food stamps) rose for the 24th consecutive month (it has since risen again in April and May). Meanwhile, enrollment rose for the 15th straight month in March in SoonerCare (Medicaid), the federal-state health insurance program for low-income individuals in various categories.

This chart (which is based on DHS monthly statistical bulletins available here) shows monthly participation for both programs going back to January 2008: Read the rest of this entry »

This is the second of what will be an ongoing series of posts looking at the impact of the new federal health care reform law on Oklahoma and Oklahomans. The first looked at how reform will mitigate the public benefits “cliff effect”. For full information on health care reform, the Henry J. Kaiser Family Foundation website is excellent.We encourage your contributions as comments or as  a guest blog.

The passage of the new federal health care law represents a monumental shift in the nation’s health care delivery system that will unfold over the coming years. States and state governments will be effected by the new law in myriad ways, only some of which are recognized at this early stage. One issue that has caused some concern for state governments, particularly in the context of the deep and prolonged state fiscal crisis, is the obligation that states will eventually be asked to assume for a portion of the cost of covering the newly insured.

With the passage of health care reform, the Oklahoma Health Care Authority has estimated that an additional 250,000 Oklahomans will be newly qualified for Medicaid, the nation’s primary health insurance program for the poor, jointly financed by the federal and state governments.  Under the law, all working-age  adults with household incomes up to 133 percent of the federal poverty level – around $24,000 for a family of three in 2009 – will become eligible for Medicaid effective in 2014.  Read the rest of this entry »

OK Policy has argued repeatedly  that next year’s budget outlook, with shortfalls equal to cuts of 12 percent across all agencies of state government above those already enacted this year, threatens to have catastrophic consequences for the state’s economy, businesses, and families (see our budget page for an op-ed, issue brief and fact sheet, or this blog post). Here we examine the especially grim options for dealing with budget shortfalls faced by the Oklahoma Health Care Authority (OHCA), the state agency responsible for administering the state Medicaid program that serves nearly 700,000 low-income Oklahomans, primarily low-income children, seniors, pregnant women, and persons with disabilities.

At recent legislative hearings, the agency outlined next year’s budget situation. This year, the agency’s state funding – after budget cuts and including $33 million in additional funds that were authorized as part of the mid-year “supplemental” approved by the Legislature – is $980 million. As a result of increased enrollment and utilization, OHCA estimates that it will need $1.098 billion in state appropriations to maintain the Medicaid program in FY ’11 at its current levels. If, as is possible, the Legislature were to remove the supplemental from OHCA’s base and cut funding by an additional 10 percent, its appropriation for FY ’11 would be some $850 million. Thus, OHCA anticipates that it could be facing a shortfall for the coming year of some $250 million in state funds. With the corresponding loss of federal matching funds, the program would face the challenge of enacting total cuts of at least $1 billion. Read the rest of this entry »