State Lawmakers Divided Over Medicaid Expansion Program


March 11, 2021

Editor's note: This story was updated on March 23, to correct an uploading error. Previously, the phrase "the best Medicaid programs in the nation," was missing from paragraph four. We apologize for any confusion caused by this omission.

The expansion of Oklahoma's Medicaid program is constitutionally mandated by State Question 802 to take place by July of 2021, but state lawmakers are still divided over funding and implementation.

Gov. Kevin Stitt, R-Tulsa, has been pushing managed care for Oklahoma's Medicaid program even before the expansion was approved, according to a press release from June 18, 2020. Managed care is an implementation system in which Oklahoma's medicaid provider, the Oklahoma Health Care Authority (OHCA), contracts with private insurance companies to provide coverage for Medicaid-qualified individuals. Opponents of managed care contend that involving both the OHCA and private companies creates an unnecessary middleman.

Under Oklahoma's current Medicaid system, the OHCA manages Oklahoma's various Medicaid programs, including SoonerCare.

In December of 2020, Stitt's managed care plan received major legislative pushback, in the form of a letter from Republican legislators. According to a legislative press release, 10 Republican lawmakers called on Stitt to reconsider his plan, and work with legislators to implement the required expansion of Medicaid. These lawmakers claimed that states who manage their Medicaid in-house, like Oklahoma currently does, have the best Medicaid programs in the nation.

"Furthermore," the letter reads, "the states performing the worst all have commercial managed healthcare programs. Why would we change to a managed care program when ours has been recognized as one of the best in the nation?"

During the governor's Feb. 1 "State of the State" address to lawmakers, Stitt again asserted that managed care is the best path forward for Oklahoma.

"It's not a red-state thing or a blue-state thing, it's the smart thing to do," Stitt said.

Much of Stitt's speech was punctuated with bursts of applause from the assembled audience. But although the address was delivered to a majority Republican audience of state legislators, the room was notably silent throughout the governor's comments supporting managed care.

Although Stitt announced in January that four companies had been chosen for managed care contracts, these arrangements are far from final. Emma Morris, health care policy fellow at the Oklahoma Policy Institute, said state legislators still have an opportunity to step in and decide how Medicaid will be implemented.

The contracts for managed care providers, Morris said, have a clause stating that the contracts will be terminated if the proper state and federal approval is not received, or if the program is not funded.

"So it seems there is an opportunity for the legislature to not fund, or to specify that money can't be used for managed care," Morris said.

Rep. Danny Sterling, R-Tecumseh, said he supports implementing Medicaid expansion through traditional OHCA management in an email to The Countywide & Sun. And as far as funding sources, Sterling said rapidly growing revenue from Oklahoma's medical marijuana program should be considered.

But Sterling said he's concerned about the potential effects that managed care, and Medicaid expansion in general, may have on Pottawatomie County residents.

"I am concerned about the real possibility of long term detriments for our county," Sterling said. "Especially since the number of providers might actually decrease instead of increase. Especially given the past failures of managed care in our state."

Additionally, he said the legislature has a part to play in determining Medicaid expansion's implementation mechanism, and said the governor shouldn't be pushing ahead with managed care without legislative approval.

Rep. Dell Kerbs, R-Shawnee, offered his thoughts on the issue via written statement on Feb. 22. Kerbs didn't offer explicit support for either managed care or OHCA administration, but agreed the state legislature should be taking an active role in the decision making process.

"The question is more complicated than supporting or opposing Managed Care," Kerbs' statement reads. "It is essential to determine what the managed care looks like, what services are the companies providing, and at what cost?"

No matter what, Kerbs said, Medicaid expansion will increase coverage and access to healthcare for people across Pottawatomie County. And whether the program is administered through the OHCA or managed care contracts, Kerbs said the legislature will have to come up with a source of recurring revenue to pay for the expansion.

"We must make sure that each dollar spent through the Medicaid program is wisely spent to help improve the lives of Oklahomans," Kerbs said, "while also recognizing that the taxpayer is footing the bill for these services."

The Countywide & Sun also reached out to Sens. Zack Taylor, R-Seminole, and Shane Jett, R-Shawnee, for comments on the issue. Sen. Jett's office declined to offer comment on the topic, and Sen. Taylor had not responded to the requests by the time of this story's publication.

For more information Medicaid expansion's projected effects on Pottawatomie County, see a related story elsewhere in this week's edition of The Countywide & Sun.


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