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 »

This is the sixth in an ongoing series of posts examining the Affordable Care Act, including previous posts on the Temporary High Risk Pool and tax credits for small businesses.  You can also visit the health care reform page on our website for more resources and information.  If you have thoughts on health care reform, we encourage you to comment below or contribute a guest blog.

One of the most important provisions of the federal health care reform law, officially known as the Affordable Care Act (ACA), is the requirement that states establish private insurance marketplaces, or ‘Exchanges’, to sell plans to individuals and small groups in their state.  Health insurance exchanges were written into the law to ensure that these particularly vulnerable segments of the market – individuals and small groups – could obtain affordable coverage.  What is unique about these segments?  Well, consider how insurance works for a large group employer:  every employee is covered regardless of medical history and all employees pay roughly the same premiums.  This is possible, and perhaps more importantly profitable, because the risk of covering the sicker/costlier employees is offset by the ease of covering healthier/cheaper employees. Read the rest of this entry »

“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 »

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 »

According to the latest U.S. Census figures, 565,000 Oklahomans, or 15.8 percent of the total population, were without health insurance in 2007-2008. The uninsured rate is just under 10 percent for children but over 20 percent for adults ages 18-64.

The Oklahoma Legislature has made several efforts in recent years to chip away at the number of uninsured by expanding eligibility for Insure Oklahoma, a program that provides public subsidies towards the purchase of employer-sponsored coverage for employees of small businesses or a public product for those without access to employer coverage. Eligibility for Insure Oklahoma goes up to 200 percent of the federal poverty level ($44,000 for a family of four) and is available to employees of businesses with up to 250 employees. Read the rest of this entry »

In the early 1990′s, faced with health care costs that were rising at unmanageable rates and widespread dissatisfaction with the quality of the state’s Medicaid program, the Oklahoma Legislature created the Oklahoma Health Care Authority (OHCA) as  a stand-alone agency whose primary mission would be to convert the state’s fee-for-service Medicaid program into a primarily managed care program. To implement managed care, the state submitted a Section 1115 demonstration waiver for the program, which would come to be known as SoonerCare. Earlier this year, Mathematica Research, a nationally-recognized evaluation company, delivered a comprehensive 1115 waiver evaluation on the SoonerCare program since its inception. You can access an Executive Summary of the findings, a PowerPoint, or the 175+-page full report. Read the rest of this entry »