Medicaid expansion, making low-income Oklahomans ages of 19 to 64 newly eligible for coverage, seems to be going well. The Oklahoma Health Care Authority (OHCA) reports that more than 158,000 Oklahomans have been approved for benefits since June 1, and enrollment continues at a rate of 1,000 per day. In addition to the newly eligible, Medicaid in Oklahoma will now cover certain mental health and substance use disorders that were previously paid for by state dollars only.
It’s a different story with Medicaid managed care, which would have transferred management of Medicaid from OHCA to four private insurance companies. The OHCA managed care plan was halted when the Oklahoma Supreme Court struck it down because OHCA did not have legislative approval for implementing it, and the agency had failed to promulgate rules for its request for proposals (RFP). The court ruling invalidated the $2 billion in contracts already signed with the companies.
But during session, the legislature passed Senate Bill 131 for the purpose of imposing limitations on Medicaid managed care, and some believe the legislation unintentionally gave approval for it. Health care provider groups, who practically unanimously opposed managed care, now are wondering what’s next. It’s interesting. I’ve talked with several legislators recently who would almost certainly be among the first to know if and when the governor is planning to continue his push for managed care. No one seems to know, which probably means Gov. Stitt, who directed OHCA to issue the RFP last year, is keeping his options open.
One hint will come if OHCA begins the rulemaking process to promulgate the rules necessary to issue new RFPs. If it does, the proposal may meet the same opposition from health care providers and legislators as last year. Several important legislators and legislative leadership are on record saying it would be a misuse of SB 131, even if the legislature did inadvertently authorize managed care, to use it for that purpose. That may not be politically healthy while the governor is already in full swing raising money and preparing to campaign for re-election. If he waits until he is re-elected, he could likely argue that he has a mandate to implement managed care.
If there is a managed care proposal 2.0 in the future, it should have the advantage of time and lessons learned from this year’s fiasco. The rushed process, trying to get the contracts signed before the legislature could come into session and act to prevent it, left lots of unanswered questions and kept what could possibly have been helpful input from happening. If managed care is worth doing, it is surely worth doing as well as it can be done.