Oklahoma leaders ponder ways to stabilize state’s shaky Medicaid program (Tulsa World)

By Barbara Hoberock 

OKLAHOMA CITY — Officials unveiled on Thursday the framework of a proposal to provide subsidized medical insurance to more Oklahomans.

The proposal also calls for moving thousands of people who are on Medicaid into the private market through an expansion of Insure Oklahoma.

Policymakers were quick to say this is not an expansion of Medicaid under the federal Affordable Care Act, something that has been rejected by the state of Oklahoma.

The proposal comes as a Senate panel rejected a bill to remove 110,000 people from the state Medicaid program and the state agency that administers Medicaid announced that it is considering cuts of up to 25 percent for medical providers in the program.

The state is experiencing a revenue failure for the current fiscal year and expects to have $1.3 billion less in the fiscal year 2017 budget.

Oklahoma Health Care Authority CEO Nico Gomez said Gov. Mary Fallin and others asked his agency to come up with proposals to help stabilize the state’s Medicaid system. The Health Care Authority is the state’s Medicaid agency.

Gomez met with legislative leaders and others on Thursday to discuss the proposal, dubbed the “Medicaid Rebalancing Act of 2020.”

The plan calls for creating a new Insure Oklahoma program option for state residents who are currently uninsured, according to the agency.

Created about a decade ago, Insure Oklahoma provides subsidized insurance. The expansion would cover adults 19 to 64 years old who have incomes below 133 percent of the federal poverty level.

They would pay premiums based on a sliding scale tied to income, Gomez said.

It would insure 175,000 Oklahomans who are currently uninsured and not in the Medicaid program, Gomez said.

It would cost the state $100 million, which would be matched with federal dollars.

The proposal also calls for moving some clients of SoonerCare, the state’s Medicaid program, to the private health insurance market. Those members would be eligible for federal tax credits, called advanced premium tax credits, to support the premium costs, Gomez said.

“They will have the responsibility to pay for premiums or whatever co-payments are applicable,” he said.

The change would move 175,000 pregnant women and children to private insurance plans and save the state $60 million, officials said.

Gomez reiterated that the plan is not an expansion of Medicaid.

“We are talking about shrinking the size of SoonerCare and increasing Insure Oklahoma,” Gomez said. “There is no net increase to the program.”

“The plan would use federal funds that other states have used to expand Medicaid, but instead of expanding Medicaid, Oklahoma would create a private option,” said Gene Perry, Oklahoma Policy Institute policy director.

“The idea was first tried in Arkansas and has been subsequently adopted in several other states,” Perry continued. “The private option has been successful at dramatically reducing the uninsured rate while restraining the growth of Medicaid programs.”

House Speaker Jeff Hickman, R-Fairview, said the proposal is “not at all” a Medicaid expansion, adding that the House would not support a plan that would add to the number of people on Medicaid.

A lot of the details of Gomez’s plan have yet to be worked out, Hickman said.

While Gomez said earlier this week that the Oklahoma Health Care Authority is considering the possibility that it might have to cut Medicaid provider rates by up to 25 percent, the proposal announced Thursday calls for stabilizing provider rates and bringing them up to at least 86 percent of the Medicare fee schedule. Such a move would reduce the amount of uncompensated care for hospitals and other providers.

Officials are considering a handful of financing options that could make that possible, including increasing the tax on cigarettes by $1.50 per package and a fee assessed to health insurance providers.

“If we are not able to stabilize the provider rates, then we are not going to have a very effective health-care delivery system,” Gomez said. “We are going to have a very damaged health-care delivery system.”


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