Protect SoonerCare for Oklahoma Families

NOTE:Federal regulators posted the state’s plan to cut SoonerCare coverage for parents who don’t meet a work requirement for public comment on December 20th. The piece is available for public comment and feedback until January 18th. Click here to learn more and to leave a comment.

The Oklahoma Medicaid agency is developing a proposal that could potentially take SoonerCare coverage away from low-income parents who are unable to work enough hours. Under this plan, if parents aren’t able to work a certain number of hours or aren’t able to log their hours, they’ll lose the health coverage they need.

There is no evidence that taking away coverage from a person who is unable to work enough will either increase work or improve health. Instead, it actually harms both. A draft of Oklahoma’s plan will be available for public comment until September 30th. This is an opportunity to make your voice heard and show that this isn’t good for struggling families in Oklahoma. Here’s what you’ll find on this page:

• What You Can Do
• Social Media Shareables
• Videos
• Key Points
• Additional Links and Resources 

What You Can Do 

Take action today! Public comments can shape policy. Submit a comment to the Oklahoma Health Care Authority using one of the forms below. The deadline for public comments is September 30. 

• For a quick and simple way to submit a comment, use this easy comment form.
• Not sure what to say? Use this question survey to create and send your public comment.

Social Media Shareables

 [Download all images here]  

Videos

• Save SoonerCare for Oklahoma Families
• Save SoonerCare for Oklahoma Children
• Save SoonerCare for Oklahoma Patients
• Save SoonerCare for Oklahoma Workers 
• Save SoonerCare for Oklahoma’s Workforce

Key points 

• Thousands of Oklahoma families are able to see a doctor or fill a prescription because of the state’s Medicaid program, SoonerCare. Oklahoma is asking the federal government for permission to cut SoonerCare coverage for Oklahoma parents who don’t report working enough hours every week. This proposal is deeply flawed and should be withdrawn.
• This proposal creates a Catch-22 for parents: if they work the hours needed to stay on SoonerCare, they’ll earn too much to qualify for SoonerCare. Without other health coverage options, many of these parents will join the ranks of the uninsured, without access to primary care, care for chronic conditions, treatment for mental illness, and more. This isn’t just bad for parents: it’s bad for their children.    
• Building a new system to monitor SoonerCare members’ work activities will grow administrative costs. Working families risk losing their coverage if they don’t fill out the right paperwork. However, this proposal gives almost no detail on how the state will manage that risk or what it would cost. These are important factors especially for parents with disabilities and chronic illnesses, who will lose coverage if they can’t navigate this bureaucracy successfully.  
• Some Oklahoma parents will lose their health coverage as a result of this proposal if it’s approved by the federal government. However, the proposal provides no estimates of how many. The purpose of SoonerCare is to provide access to health coverage for low-income Oklahoma families, but this proposal does not appear to consider the effect on the parents who will lose coverage under this proposal. Oklahoma families deserve to know how this proposal will impact them.
• Most parents on Medicaid who can work, already work: Those who don’t work have barriers to employment that a work requirement doesn’t address. Three in four SoonerCare members are children, according to March enrollment data. The next-largest group (15 percent) are Oklahomans who are aged, blind, or have a disability. Just 1 in 13 are non-disabled, working-age adults, and all are parents living in deep poverty – less than $12,000 per year for a family of four. Two in three of these parents are single mothers. Of the small share of parents on Medicaid who aren’t working, most have barriers to work. Some may have a persistent illness, while others may have to care for a child, a sibling with a disability, or an elderly parent. As the Executive Director of Workforce Tulsa wrote in an op-ed, tying Soonercare to work is no way to strengthen our state’s workforce.
• Losing health coverage will make it harder for low-income parents to work, with disastrous consequences: If parents lose their SoonerCare because they don’t report enough hours and then get sick, or can’t afford medication for a chronic condition like asthma or depression, they’ll be less able to work. Their whole family will suffer as a result. This may result in children losing coverage, because children are more likely to have health coverage when their parents do. It may also mean more children enter foster care, as sick and uninsured parents are unable to care for them.

Additional Links & Resources

• Non-expansion states can’t fix “catch-22” in their proposals to take Medicaid coverage away from parents not meeting work requirements: Inall of these states, substantial numbers of parents likely couldn’t meet the requirements, whether because of caregiving responsibilities coupled with a lack of affordable child care, because they work at unstable jobs that don’t provide enough hours of work every month, because of an illness or disability, or for other reasons.In many of these states, the proposals would also create a severe catch-22: Even parents who did manage to comply with the work requirement would often lose coverage [Center on Budget and Policy Priorities].
• Implications of work requirements in Medicaid: What does the data say?: Work requirements could have implications for Medicaid enrollees who are working, as they still need affordable health insurance, may face challenges consistently obtaining enough hours, and will still be subject to new reporting or documentation requirements to maintain coverage. Even though most Medicaid enrollees who work are working full-time for the full year, most are working in service jobs with limited benefits such as sick time or health coverage, and even when working, adults with Medicaid face high rates of financial insecurity [Henry J Kaiser Family Foundation].
• These are the people who would lose under Medicaid work requirements: But these findings, which track with other research we’ve seen, raise questions about the practical value of these requirements. Most Medicaid enrollees, it seems, already are working or can’t reasonably be expected to work. And of the population that might seem like the logical target of a work requirement, most have significant physical or mental health needs — so why would we want to institute a policy that could lead to them losing health insurance? [Vox].
• Harm to older Americans from taking away Medicaid for not meeting work requirements: Losing coverage worsens health for all groups, which is why physician groups like the American Medical Association, the American Academy of Family Physicians, the American Academy of Pediatrics, and others oppose Medicaid work requirements. But the resulting coverage losses would likely be especially harmful for older enrollees, because of their high rates of chronic conditions. For people with serious health needs, coverage interruptions lead to increased emergency room visits and hospitalizations, admissions to mental health facilities, and health care costs, research has shown [Center on Budget and Policy Priorities].
• Many devils in the details as Oklahoma moves toward a Medicaid work requirement: A work requirement in Oklahoma will affect tens of thousands of struggling parents, as well as their children and families. Furthermore, no other state has yet implemented such a requirement, and the Medicaid programs of states whose plans have been approved differ significantly from Oklahoma’s. Oklahoma administrators will need to tread very carefully to ensure that Oklahoma does not create more barriers to health and employment in implementing their work requirement [OKPolicy]
• Oklahoma’s work requirements for Medicaid criticized in new report: A report by the CBPP, however, suggests that the requirement of working at least 20 hours per week doesn’t put people in a stable environment to continue receiving benefits. “Among people working 1,000 hours over the course of a year, which is over 80 hours a month on average, one in four would fail to meet an 80 hour-per month requirement in at least one month,” Solomon said. “That’s in large part because many low-wage workers are in unstable jobs with hours that fluctuate” [NewsOK].
• Shelley Cadamy: Taking away health coverage is no way to strengthen Oklahoma’s workforce: I’m a workforce development director, and when I talk with employers about work requirements, they’re initially excited. That excitement fades when they learn that people will lose their health benefits if they don’t work. When I let them know that 85 percent of working-age SoonerCare members are already or were recently working, their excitement fades further. And when I tell them that of those who don’t work, two in three are ill or disabled, or are caring for children or aging parents, they’re no longer excited. SoonerCare is a health care program, not a jobs program. If our goal is to fill the jobs that Oklahoma companies desperately need filled, we should instead fully fund the Workforce Innovation and Opportunity Act, which actually is a jobs program [Shelley Cadamy / Tulsa World].
• Oklahoma should avoid the temptation to pass new Medicaid restrictions: Clearly, work requirements won’t result in widespread movement of SoonerCare members into the workforce – after all, most are either children or are already employed. Work requirements won’t help members who aren’t in the workforce already get there, as they face barriers to employment a work requirement won’t address. However, work requirements will make it more difficult for very low-income parents to access basic health care. They will result in people needlessly losing coverage. They will be expensive for the state to implement and maintain. Is that what we want? [OKPolicy].
• Arbitrary and Capricious: Kentucky can’t require Medicaid beneficiaries to document work in order to have coverage: Judge James Boasberg ruled that the Secretary’s approval of the 1115 waiver was arbitrary and capricious because he failed to address a salient factor – that is, the purpose of the Medicaid program to furnish medical assistance. His order vacates the Secretary’s approval of the Kentucky waiver and remands it to the U.S. Department of Health and Human Services [Georgetown University Health Policy Institute].
• First, get a job: Arkansas’s Medicaid work requirements begin: Yet health care advocates warn that Arkansas’s experiment could nonetheless lead to thousands losing insurance, including many who are now working. One reason is that documenting the work activities of some 69,000 people each month will entail a dense new web of red tape. It’s not enough to simply have a job; beneficiaries must report their work habits monthly through an online portal set up by DHS. Reporting by mail or phone will not be allowed — though the website may be unavailable up to 10 hours every day [Arkansas Times].