The 2021 session proved a mixed bag for health issues

Oklahomans across the state will soon be able to more easily visit a doctor or fill a prescription, thanks to voter approval of State Question 802 and legislators’ decision to fully fund Medicaid expansion. Though the Legislature failed to legislatively halt the governor’s proposed transition to privatized managed care (something that would make the state’s Medicaid administration unnecessarily complicated), the June 1 Supreme Court ruling effectively stopped the Governor’s managed care plan. With Medicaid expansion finally funded, the state now has a number of common sense options to maximize federal Medicaid spending and further ensure access to high-quality, affordable health care for all. 

Legislators expanded access to medical and dental health care for many Oklahomans

Medicaid expansion, passed by voters in June 2020, will bring significant health benefits, increased financial stability, and a consequential economic investment to Oklahoma. A decade after expansion became an option for states, expansion enrollment will begin on June 1 with coverage beginning on July 1, 2021

The state’s share of Medicaid expansion costs will be fully funded. This year, it will be funded by a mix of federal funds from the American Rescue Plan Act (ARPA) and a phased increase in the Supplemental Hospital Offset Payment Program (SHOPP) fee, a fee paid by hospitals. Future years will be primarily funded by the SHOPP increase.  Lawmakers scheduled the SHOPP fee to increase in Jan. 2021, despite the ARPA providing funding to cover the state’s share for the first two years. 

Oklahomans insured by SoonerCare, Oklahoma’s Medicaid program, will soon have access to expanded dental services as well. SoonerCare currently only offers severely limited dental coverage. The Legislature, however, directed the Oklahoma Health Care Authority (OHCA) to spend $17 million to expand dental coverage, and the agency recently announced intentions to do so.

Just days after the end of session, the Oklahoma Supreme Court invalidated OHCA’s attempted transition to a privatized managed care model due to lack of legislative approval, leaving the state with more questions than answers about what comes next. Though it’s unclear where the Governor and the Legislature will go next on managed care, legislators passed Senate Bill 131, a comprehensive bill that places guardrails on managed care organizations (MCOs) and provides important protections for patients and providers if the state eventually moves forward with a managed care model. Despite the debate over how the state manages its health care program, Medicaid expansion is on track to take effect in Oklahoma on July 1, which will ensure health care access for thousands of low-income Oklahomans who have gone too long without it. 

Lawmakers missed several opportunities to invest in Oklahomans’ health 

Many Oklahomans who are waiting for home- and community-based services (a program that provides in-home care to older individuals and people with disabilities) will have to wait at least another year to see that assistance come to fruition. The American Rescue Plan Act (ARPA) gives states the option to receive increased federal aid for this program; but rather than capitalizing on this opportunity, legislators made this care even more inaccessible by prohibiting people from even applying until they have lived in the state for five years. This likely unconstitutional bill was opposed by disability advocates and others, who are dedicated to addressing the state’s decade-long waiting list by making sure all those who need this care can access it, not by imposing arbitrary limits. 

Additionally, legislators failed to reinstate local control of several issues. Due to the preemption doctrine, cities and counties are prohibited from addressing issues like tobacco use, firearms, and workers’ rights, even when citizens want their local governments to do so. House Bill 1893, which never even got a hearing, would have repealed the tobacco preemption law, allowing cities to take more action to protect the health of and air quality for their residents. The COVID-19 pandemic reiterated the importance of local governments’ authority to act on public health, but state leaders ignored this opportunity to place more control in local leaders’ hands. 

Patient advocates and providers will have fewer opportunities to engage with the state’s Medicaid program because of SB 689, which makes changes to a key advisory committee. The Medical Advisory Committee (MAC), composed of patient advocates and provider representatives, advises the OHCA about health and medical decisions. This bill halves the number of MAC representatives and removes the requirement that it include a representative of the “economically disadvantaged.” While it does add a Tribal representative, this could have been done without limiting other voices.

Looking ahead, we have several opportunities to prioritize health 

When Medicaid expansion goes into effect on July 1, 2021, our state will have taken a good first step towards improving access to health care. Because many newly eligible individuals won’t know about their new coverage option, Oklahomans need to engage in a collective community effort to connect our friends and neighbors to care. The early enrollment period began on June 1 and will now be continuously open, and individuals can apply online at www.mysoonercare.org or by calling 1-800-987-7767. 

The OHCA reported on June 4 that more than 51,000 Oklahomans had already been approved for coverage beginning on July 1. As we move past the expansion implementation and the issue of privatized managed care, it will be vital that advocates and lawmakers alike continue to demand transparency and patient protections for all Oklahomans who are insured by Medicaid, regardless of how the program is administered. 

While Medicaid expansion is a step forward for Oklahoma, other upcoming opportunities will help the state build on this progress and move further towards health equity. The ARPA federal relief bill provides states with a way to expand postpartum coverage from 60 days to a full year for women who are insured by Medicaid, which would help begin to mitigate the state’s high rate of maternal deaths during or after childbirth. The ARPA also increases funding for the home- and community-based services program for states that request it. In Oklahoma, where the waiting list for these services is about 13 years, these funds could help open up new spots and get people the care that they need. And finally, connecting people leaving incarceration to health care would help facilitate better access to treatment of chronic conditions, mental illness, and substance use disorder. 

This year, the Legislature took some good steps in expanding access to care for many Oklahomans who need it. Moving forward, however, more needs to be done if we want to meaningfully improve Oklahoma’s health outcomes. This will require lawmakers to make smart, multi-faceted investments in all of the socioeconomic and environmental factors that can help ensure healthy, thriving Oklahomans

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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