Waiver proposal is a threat to health care for thousands of Oklahoma parents and caretakers

Thousands of Oklahoma families are able to see a doctor or fill a prescription because of the state’s Medicaid program, SoonerCare. But instead of working to strengthen this proven, cost-effective program, Oklahoma is asking the federal government for permission to cut off Oklahoma parents and caretakers who don’t report working enough hours every week. SoonerCare was built to ensure that low-income families get essential health care, not to punish families for losing a job or missing some paperwork. The state’s new proposal is unworkable and should be withdrawn.

The proposal creates serious problems for Oklahoma families, with or without jobs. Most non-elderly adult Medicaid enrollees work, but they have low-wage jobs that generally do not offer health insurance and are often unstable, with frequent job losses and work hours that can fluctuate sharply from month to month. As a result, many working parents would be at risk of losing coverage for one or more months under this proposal.

Furthermore, the proposal shows little regard for what happens if parents work themselves into the coverage crater by earning more than 46 percent of the federal poverty level (about $630 per month for a single mother with one child). SoonerCare already cuts off at this income, which is only slightly above minimum wage for some families. Under this proposal, parents face a Catch-22. If they manage to work the hours needed to stay on SoonerCare, they would make too much to remain covered — even though they are still earning far below the poverty level. When that happens, they may not have other options to keep the health coverage they need.

This proposal would cut health coverage for people who don’t or can’t follow its rules, with catastrophic effects for entire families. However, this new proposal from the state remains silent on even the basics of how this would be implemented — let alone what it would cost. There’s no detail on how work or volunteer hours would be tracked or verified or what documentation members must provide to prove their compliance. Similarly, there’s no information about how or how frequently members will need to prove they qualify for an exemption. This is particularly important for parents with chronic illnesses or disabilities who, whether working or seeking an exemption, may struggle to provide necessary documentation and lose the health care they need as a result. There’s also no information about good-cause exemptions — will a parent lose coverage if she’s in the hospital when she’s supposed to be uploading a pay stub?

Most crucially, the proposal provides no estimates of how many Oklahomans would lose their health coverage, even though it indicates that some coverage loss is anticipated. Oklahoma’s uninsured rate is already among the highest in the US, and losing health coverage can be catastrophic for the working families who use SoonerCare to get a checkup, control a chronic condition, treat mental illness, and more. The purpose of SoonerCare is to provide access to health coverage for low-income Oklahoma families. This proposal does not appear to consider the effect on those who will lose coverage under this proposal. Before Oklahoma proceeds down this risky path, Oklahoma families deserve to know how they will be affected.

Ultimately, this proposal underestimates or leaves out the costs of administrative burdens on the Health Care Authority, doesn’t account for reporting burdens on very low-income parents, and doesn’t consider the statewide burden of a spike in the uninsured rate and more parents unable to see a doctor. SoonerCare is not a jobs program. This attempt to distort it into one will only increase costs and prevent Oklahoma families in poverty from getting the care they need.