Twenty-five elderly Oklahomans lost their home early last week when Wynnewood Care Center closed.
After taking years of reimbursement cuts and expecting more to come, the small skilled-nursing facility in Wynnewood had to shut down and move residents into other facilities in neighboring counties.
Then on Thursday, the Oklahoma Health Care Authority (OHCA) voted to cut daily reimbursements to nursing homes, residential facilities housing people with intellectual disabilities, and nursing facilities for people with AIDS by 4 percent. They also voted to cut payments to most Medicaid providers by 9 percent. Unless lawmakers pass a budget deal that fills all or most of the $70 million hole in OHCA’s budget triggered when the state Supreme Court struck down an unconstitutional cigarette tax, these cuts will take effect on December 1.
Similarly, although state-funded in-home care isn’t scheduled to expire until December 1, thousands of Oklahomans with disabilities and their caregivers are scrambling now to find alternatives. Nearly 189,000 Oklahomans who manage mental illness and addiction through state services are in a similar boat; nearly all outpatient service are scheduled to cease on December 1. While $23 million from the Rainy Day Fund may allow them to delay those cuts for a few weeks, the Department of Mental Health and Substance Abuse Services still has a $50 million budget hole to contend with.
If lawmakers can come to an agreement in time, these cuts can be stopped — but as Wynnewood’s closure shows, a lot of damage has already been done.
Cuts and uncertainty are doing lasting damage to Oklahoma’s health care infrastructure and economy
When it comes to health care, cuts to state agencies translate to cuts for businesses. State agencies contract with thousands of businesses and organizations for everything from medical equipment like wheelchairs to counseling and skilled nursing. The state Department of Mental Health and Substance Abuse Services (ODMHSAS) alone estimates that some 700 businesses and nonprofits with thousands of employees will be affected by the agency’s impending cuts. Some will certainly close, while others may be forced to eliminate services and lay off staff. Even Oklahomans with private insurance may lose care or face long waits elsewhere if their provider shuts down, and prices will grow to offset uncompensated care costs. Many parents and caretakers will have to quit their jobs or shut down businesses to take care of family members, forcing further reliance on diminishing safety net care.
This also means more Oklahomans in crisis will have no options left but emergency rooms – or they may have no nearby options whatsoever. More than three dozen Oklahoma hospitals are barely above water. Further saturating emergency rooms will stretch their budgets even more, jeopardizing hospital access across the state. Such cuts and closures will exacerbate the state’s growing health care provider shortage. Agencies and private businesses are already making cuts in the absence of a budget agreement, and it will be much harder to bring these businesses and health care workers back once they’re gone.
Effects on Oklahomans will range from tragic to deadly
Most Oklahomans who get care through the state don’t have other options — and it’s a lot of people. OHCA covers more than one million Oklahomans annually through SoonerCare, two in three of whom are children. Approximately 1 in 20 Oklahomans access outpatient services through ODMHSAS. Twenty-five thousand people have longer life and better health outcomes living in their own homes because of DHS. All will lose care if these cuts go through.
The effects of losing this care will be tragic and deadly. For example, hundreds of Oklahoma women get medication-assisted treatment through ODMHSAS to manage opiate addictions during pregnancy. If access to that treatment is disrupted, it will dramatically increase incidents of miscarriages or other severe impacts on a developing fetus due to addiction. Similarly, thousands of Oklahomans serving alternative sentences through drug court or mental health court may find themselves sent to prison, locked away from families, jobs, communities, and treatment. Nearly half of all children in rural areas are on SoonerCare — many will lose access to basic care if their providers drop SoonerCare or close. Family of people with disabilities may be forced to quit jobs and sell businesses to take on more caregiving duties. Elderly Oklahomans could be forced out of their family homes and into underfunded nursing facilities with strangers. The pain, trauma, and deaths that will result from these cuts can’t be reversed.
Without a sustainable budget solution, these threats will return
In the face of oncoming calamity and a general refusal to consider compromise, some lawmakers will likely be tempted to combine whatever small funding increases can be passed with a simple majority, Rainy Day funds, and more cuts to agencies. Lawmakers could spread the cuts around to prevent core health and human services from taking all of the pain. This might stop the immediate bleeding, but it only deepens the problem of Oklahoma’s structural budget deficit. That means we will find ourselves with an even larger budget hole — and with fewer options for dealing with it — when lawmakers come back for regular session in just a few months.
Unfortunately, Oklahomans have already been harmed, no matter what lawmakers manage to pass out of special session. The dire threat of losing life-saving has been looming for months over Oklahomans who already have enough to struggle with battling addiction or trying to care for a loved one with a serious disability.
Legislators know they have multiple good options to raise recurring revenues. The outlines of the deal needed to raise enough revenues in a fair way have been clear for months and nearly passed last week. Lawmakers know that’s what their constituents want them to do – and they know what will happen if they fail to come to a true agreement. There are no excuses left.