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This Week from OK Policy
Implementing community schools would better serve child well-being in Oklahoma (Capitol Update): The recent 2024 KIDS COUNT® Data Book – published by the Annie E. Casey Foundation and its state partner the Oklahoma Policy Institute – is not good news for Oklahoma. The report is a national and state-by-state comparison of child well-being. Oklahoma ranked 46th overall. There are likely many explanations. Among the solutions suggested by the report is more investment in community schools. [Steve Lewis / Capitol Update]
Weekly What’s That
Managed Care
Managed Care is a health care delivery system organized to manage cost, utilization, and quality. Unlike a traditional fee-for-service system, in which a provider is paid directly by an insurer for every service delivered, under managed care, an insurance company, organization, or provider is responsible for providing a specified set of services for each insured member in return for a set monthly payment, known as the capitation rate.
A managed care organization is an entity that receives a capitated payment and coordinates a patient’s care through a defined network of physicians and hospitals. An HMO, or Health Maintenance Organization, is a variety of managed care organization that typically requires patients to seek care from doctors and other providers who work for or contract with the HMO. In exchange for being limited in their choice of providers, patients enrolled in an HMO typically have lower out-of-pocket costs than in a fee-for-service plan.
From 1995-2004, Oklahoma’s Medicaid agency, OHCA, ran two managed care program. A fully capitated managed care HMO program, known as SoonerCare Plus, operated in urban areas but was discontinued in 2004. The second program, SoonerCare Choice, operated in rural areas only from 1995-2004 and then statewide from 2004-2023. Under the SoonerCare Choice program, most children and working-age adults selected or were assigned to a Primary Care Provider/Care Manager (PCP/CM), who received a monthly capitated payment for coordinating the care of each of their patients.
After several failed attempts to relaunch a capitated managed care program under Governor Kevin Stitt, the Legislature in 2022 passed SB 1337 requiring the state to issue a request for proposal and to award at least three Medicaid managed care contracts to health plans or provider-led entities like accountable care organizations to take effect by October 2023. In addition, a separate statewide contract would be awarded to a health plan to provide comprehensive integrated health coverage to foster children, former foster children up to 25 years of age, juvenile justice-involved children, and children receiving adoption assistance. The RFP (Request for Proposals) for the new program, known as Sooner Select, was released in November 2022 and was expected to provide medical, behavioral, and pharmacy coverage to nearly one million eligible recipients. A month later, OHCA announced that the implementation date for Sooner Select had been deferred to April 2024.
In June 2023, OHCA announced the results of the RFP process. The contracted entities selected to serve the medical plans are Aetna Better Health of Oklahoma, Humana Healthy Horizons of Oklahoma and Oklahoma Complete Health, which was also awarded the contract to serve the children’s specialty program. A lawsuit against OHCA was filed by a non-selected provider, United HealthCare, alleging violations of the Oklahoma Open Records Act.
Look up more key terms to understand Oklahoma politics and government here.
Quote of the Week
“Eviction prevention is not a magic bullet. But it’s a key, key strategy to keep existing housing affordable. Without it, it’s the bathtub overflowing. You can sit there and watch it overflow and flood the house. Or you can turn it down, maybe turn it off. You’ve got to do something to stop the flow.”
– Michael Figgins, Legal Aid Services of Oklahoma executive director, on the success of The Right to Counsel Program, which has been implemented in Tulsa County and Oklahoma County, and yielded around $6.3 million in estimated economic benefits over the past two years, according to a recent study. [Tulsa World]
Editorial of the Week
Editorial, Tulsa World: Just because we can arrest people in homeless camps doesn’t mean we should
A common solution to the growing number of homeless people living on the streets is to arrest them. Decades of research shows that is not effective.
Tulsans — like residents in cities across the U.S. — are increasingly frustrated by homeless encampments. These impromptu camp sites are public safety risks and worsen conditions in nearby neighborhoods and businesses.
Everyone agrees that better options must be available for homeless people living outdoors.
Recently, the U.S. Supreme Court found that cities have a right to enforce bans on homeless people sleeping in public places. Often, the bans require law enforcement to issue citations and/or make arrests for violations.
The case out of Oregon argued that such a ban was cruel and unusual punishment in cities that do not have enough shelter space. A 6-3 decision disagreed and upheld the ban.
Just because a city can arrest people for being in a homeless camp doesn’t mean that should be the first or dominant solution. That ought to be a last resort.
Like the Oregon town, Tulsa also does not have enough housing for its population. A housing assessment from March 23 found that nearly 13,000 units of different levels will be needed in the next decade. About 4,000 units are needed now.
Ideally, the city would have enough housing options and programs to prevent homelessness, from having adequate low-income choices to legal assistance in eviction proceedings.
The city has made progress through efforts such as A Way Home Tulsa and partnerships with nonprofits working with homeless people. Plans for a low-barrier residential center are underway in a former nursing home and rehabilitation center near the Mohawk Park Golf Course.
Most people and families experiencing homelessness are out of sight. They are living in existing shelters, out of their cars or with family and friends. But there is a small but visible number camping in public spaces.
It’s estimated that about 30% of Tulsa’s homeless residents are experiencing mental health problems and 20% substance abuse disorders, with many struggling with those co-occurring. The most challenging group is the 15% of those showing a symptom known as anosognosia, which is a lack of awareness of being mentally ill.
Oklahoma doesn’t have enough mental health workers, as a Healthy Minds Policy Initiative report stated in November. Oklahoma’s psychiatrists are meeting only 39% of the state’s needs, and psychologists are meeting 37% of the state’s needs.
For homeless people camping outdoors, an arrest doesn’t serve as a deterrent, as Tulsa World reporter Luisa Clausen and photographer Mike Simons found in interviews with people in local encampments.
“I am not scared of going to jail for a few days. There are a lot of advocates out there who truly help and come down to see us,” said one man.
A revolving door at the jail isn’t the right solution. The status quo isn’t working, either.
Homelessness is a community problem needing community ideas and fixes. People cannot be allowed to create tent cities on public land or loiter, trespass or act in ways that harm neighborhoods.
Tulsa has the capacity to build a system that respects the dignity of homeless people while also keeping neighborhoods safe and clean.
Numbers of the Day
- $19.91/hr – Hourly wage needed for a full-time worker to afford a two-bedroom rental in Oklahoma. [National Low-Income Housing Coalition]
- 88% – Percentage of white U.S. households that receive benefits in the first year that a corporate tax break goes into effect. This is disproportionate to the the 67 percent of U.S. households that are white. In contrast, Black and Hispanic households, comprising 12 percent and 9 percent of U.S. households respectively, each receive only 1 percent of the benefits that remain in the U.S. [Institute on Taxation and Economic Policy]
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85% – Percentage of Americans who said most elected officials don’t care what people like them think. This rate has increased steadily since 2000, when about 55% of Americans felt this way. [Pew Research Center]
What We’re Reading
- Out of Reach: The High Cost of Housing: For far too long, accessible, safe, and affordable housing has been out of reach
for millions of the nation’s lowest-income renters. Although most indicators show that the economy is strong, the lowest-income renters continue to confront significant challenges finding and maintaining access to safe and affordable rental housing. Insufficient wages, rising rents, and an inadequate housing safety net all contribute to the problem. Substantial, long-term investments in affordable housing solutions are desperately needed to address this crisis once and for all. [National Low-Income Housing Coalition] - Who Benefits and Who Pays: How Corporate Tax Breaks Drive Inequality: Policies that provide corporate tax breaks and allow corporate tax avoidance exacerbate racial and income disparities in our economy. These policies limit revenue raised that could finance public investments that benefit everyone. They also shift the distribution of income in favor of the owners of corporate assets, who are disproportionately wealthy and white. Finally, corporate tax policies funnel resources to foreign investors who own a large portion of shares in U.S. corporations. [Institute on Taxation and Economic Policy]
- 7 Facts About Voting — and Myths Being Spread About Them: Voter fraud is extremely rare, and there is simply no evidence to support claims that it is widespread. In this piece, we separate fact from fiction. [Brennan Center for Justice]
