In late December 2022, Congress passed an omnibus appropriations bill that includes several health provisions that will have meaningful impacts for Oklahomans. These provisions include one year of continuous eligibility for children who are insured by Medicaid, a permanent extension of states’ option to expand postpartum Medicaid coverage, mental health investments, and more certainty around the unwinding of the pandemic-related continuous coverage protection. Taken together, these provisions will strengthen the health care safety net. This is particularly important in Oklahoma, as the state continues to rank poorly on the majority of all health outcomes due to the state’s historic underinvestment in public programs that impact health.
Investments in child, maternal, and mental health will benefit Oklahomans
The most impactful provision of the federal omnibus bill will likely be the requirement that states provide one year of continuous eligibility for all children who are insured by Medicaid, effective January 1, 2024. In Oklahoma, more than 700,000 children (or nearly half of all Oklahoma kids) will benefit from this coverage protection through SoonerCare, the state’s Medicaid program. In short, continuous eligibility ensures that enrollees maintain health insurance for a full 12-month period, regardless of income fluctuations or missed administrative requirements. This is particularly important for children, as they have no control over income changes or whether their parents fulfill administrative requirements. States have long had the option to provide continuous eligibility to children, and 34 states have taken up the option for at least some of the children insured by Medicaid. Oklahoma is not one of them. Oklahoma and its residents will see numerous benefits from this policy change, including increased access to care, improved health outcomes, more efficient health care spending, and more predictable monthly expenditures. The provision will be particularly important for low-income families and Black and Latino households, as they are more vulnerable to income volatility.
The omnibus bill also prioritizes maternal health, as it makes permanent states’ option to extend postpartum Medicaid coverage from 60 days to 12 months. Oklahoma recently adopted this option, along with an increase of the income limit to qualify for pregnancy Medicaid coverage. Now that the option is permanently available, Oklahoma can continue offering this extended coverage indefinitely, rather than ending it in 2027, as had previously been the case. Because of this extended coverage, new parents will experience more continuity of coverage, increased financial stability, increased access to providers and screenings, better management of chronic conditions, and overall, improved health outcomes.
Finally, the bill increases funding and provides new opportunities for mental health investments. The bill strengthens infrastructure for maternal mental health through increased funding for screening programs, the maternal mental health hotline, and workforce development, as well as the creation of an interagency task force focused on maternal mental health. Additionally, youth who have been involved with the justice system will have access to increased screenings and case management in the days leading up to and after release from incarceration, effective Jan 1, 2025. Notably, states will also have the option to provide Medicaid coverage to some youths who are pending disposition of charges, beginning in 2025. When it comes to mental health, Oklahoma ranks among the nation’s top 10 states for highest rate of residents who are in frequent mental distress. These funds and requirements will be a good first step toward addressing the state’s mental health crisis.
The bill provides more certainty around the unwinding of the pandemic-related continuous coverage requirement
In addition to the increased investments in health, the omnibus bill outlines requirements and safeguards for Medicaid enrollees as the state returns to normal Medicaid operations. Since January 2020, states have been required to keep most Medicaid enrollees continuously covered, regardless of any eligibility changes, in exchange for enhanced federal funding. The omnibus bill, however, set an end date for that pandemic-related continuous coverage.
Starting on April 1, 2023, Oklahoma can begin disenrolling ineligible individuals from Medicaid coverage, and the state will have one year to initiate all renewals. (The Oklahoma Health Care Authority has stated they will complete renewals within nine months, and that they will take a “gradual,” phased approach to ending coverage for ineligible enrollees.) The bill outlines protections for enrollees, to help ensure eligible individuals maintain their coverage. These protections include using external data sources to gather enrollee information, not disenrolling people solely due to returned mail, and maintaining current Medicaid eligibility standards. Additionally, states will be required to submit monthly data reports to ensure accountability and transparency.
Finally, as long as states adhere to those requirements, the enhanced federal funding will be slowly phased out, and fully ended on December 31, 2023. Although the enhanced funding will be ending, states will continue to receive normal federal funding. Oklahoma will continue to receive a federal match of 73.6 percent for the general Medicaid population, and 90 percent for the expansion population.
Phase-Down of Families First Federal Medical Assistance Percentages (FMAP) Increases
|Medicaid Matching Rate Increase (Percentage Points)||CHIP Matching Rate Increase (Percentage Points)|
|January 1-March 31, 2023||6.2||4.34|
|April 1-June 30, 2023||5.0||3.5|
|July 1-September 30, 2023||2.5||1.75|
|October 1-December 31, 2023||1.5||1.05|
Source: Georgetown University Health Policy Institute, Center for Children and Families
Policy decisions today can help protect, build on recent health care gains
Throughout the COVID-19 pandemic, Oklahomans have seen firsthand the importance of high-quality, affordable health care. Moving forward, the state can build on that success. Now that the federal omnibus bill has passed, states must implement the provisions and ensure both Medicaid coverage and other programs are accessible and equitable. In implementing these provisions, the Oklahoma Health Care Authority and the Department of Mental Health and Substance Abuse Services should work with community groups, advocates, and impacted populations to ensure the programs best serve Oklahomans. The actions that elected officials and policymakers take in the coming months can help protect the health care gains Oklahoma has made recently. More importantly, it can provide a platform for building on these successes in the future so more Oklahomans can live healthier lives.