Oklahomans demanded Medicaid expansion. We must do it quickly and get it right.

When Oklahomans voted to expand Medicaid last year, they voted for increased access to health care, doctors, and medication for 200,000 newly eligible Oklahomans. They also voted for improved health outcomes, increased financial stability, and higher workforce participation for these newly eligible individuals, and they voted for a significant economic investment: 17,000 new jobs and $2.5 billion in new economic activity in the first year alone.

However, in order to realize these enormous benefits, the state must ensure that Medicaid expansion is implemented well and that all eligible Oklahomans can enroll in the health program. The Oklahoma Health Care Authority (OHCA) has taken some steps to make this a reality. Now, the agency must commit to developing and implementing a comprehensive outreach and enrollment assistance plan.

The early application period is a good first step 

OHCA recently announced that Medicaid expansion enrollment will open on June 1, 2021, with coverage beginning on July 1, 2021. This is a laudable action that will ensure newly eligible individuals can begin using their new coverage as soon as possible, and it will ease the burden on community partners, who will be instrumental in connecting Oklahomans to coverage. Of the five states that have expanded Medicaid in the last two years, three have opened early application periods. Idaho, Virginia, and Nebraska each allowed people to apply for expansion coverage sixty days before coverage actually took effect. In Idaho, 53,000 individuals, or nearly 60 percent of the estimated population that would qualify for Medicaid expansion, applied in the two months before coverage began. Providing an early application period will allow new enrollees to take greater responsibility for their health care and will streamline access to care for enrollees, many of whom have been delaying care due to cost and waiting years to access basic health care. 

As Oklahoma moves towards expansion implementation, individuals who have never applied for SoonerCare (Oklahoma’s Medicaid program) may be unsure when and how to enroll, and they may submit applications too early. To begin combatting this, OHCA has also committed to automatically reprocessing certain applications to screen for expansion eligibility: 

  • SoonerPlan enrollees (limited family planning coverage) will automatically transition to expansion coverage, effective July 1; 
  • People covered by Insure Oklahoma will be automatically reprocessed to determine expansion eligibility. Those with incomes above 138 percent FPL will retain their Insure Oklahoma coverage; 
  • Uninsured adults whose children are currently insured by SoonerCare, and who submit or update a SoonerCare application on or after April 1, 2021, will be reprocessed to determine expansion eligibility; and 
  • Anyone who is likely to meet the expansion eligibility requirements, and who applies on or after April 1, 2021, will be reprocessed to determine expansion eligibility. 

Despite these efforts, many Oklahomans who will be eligible for expansion do not fit into any of these categories. Reprocessing all applications, particularly those of parents whose children are insured by Medicaid, will keep eligible Oklahomans from falling through the cracks and missing out on coverage to which they are entitled. 

Outreach and enrollment efforts will connect Oklahomans to care 

Other simple steps will help eligible Oklahomans apply for and maintain coverage. OHCA can and should do more to streamline enrollment, such as implementing presumptive eligibility and automatically enrolling people based on their enrollment in other assistance programs. This would help ease the burden on newly eligible Oklahomans, without requiring substantially more work for agency staff. 

Finally, OHCA must conduct wide-reaching and intentional outreach in communities that will see particular benefits from Medicaid expansion. For example, rural Oklahomans are more likely to be uninsured than their non-rural counterparts, and some communities of color in Oklahoma are twice as likely to be uninsured than predominantly white communities. Further, many newly eligible individuals likely will not realize they will soon qualify for coverage. The OHCA should work closely with non-profit agencies, health care providers, schools, and religious institutions to distribute information about expansion enrollment, identify eligible Oklahomans, and assist with enrollment efforts during the early application period and beyond. 

A well-implemented expansion will provide more Oklahomans with quality health care 

Medicaid expansion will bring a robust and positive return on investment for Oklahoma — if it is implemented correctly. Expansion must be efficient and equitable, and the early application period lays the groundwork for making that a reality. Making an investment in targeted outreach and enrollment assistance will ensure coverage is accessible across the state. Together, these efforts will provide the baseline from which the state can move toward high-quality, affordable health care for all Oklahomans. 

Actions for Advocates: 

  • Contact the Oklahoma Health Care Authority and your legislators to tell them that Oklahomans deserve an outreach and enrollment plan for Medicaid expansion. 
  • Share your story about how you or your family can benefit from expanded Medicaid coverage, or have struggled with gaps in health care coverage.  
  • For more information, tools, actions, and resources for advocates, visit OKPolicy.org/Countdown.

ABOUT THE AUTHOR

Emma Morris serves as the Health Care and Revenue Policy Analyst at OK Policy. She graduated from the University of Oklahoma in fall 2019 with dual degrees in Women’s and Gender Studies, and Public and Nonprofit Administration. She is an alumnus of OK Policy’s Oklahoma Summer Policy Institute.

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