Medicaid

A state budget crunch could lead to less money for health care providers in Oklahoma.

Oklahoma’s state Medicaid agency may cut Medicaid reimbursements rates by up to 25 percent to make up for a state budget shortfall of almost $900 million. Preston Doerflinger, the state’s budget director, has asked the Oklahoma Health Care Authority to prepare for a possible 15 percent reduction in state appropriations. This means that companies providing services to Medicaid patients might not be fully reimbursed by the government. 

It will take a day or two for lawmakers to digest the details and assess the impact of the big budget deal unveiled Tuesday by Gov. Mary Fallin and legislative leaders. But several immediate implications appeared clear.

Budget Cuts Were Reduced By About Two-Thirds.

The Oklahoma House rejected a proposed $1.50 per-pack tax on cigarettes to help shore up the state's health care system.

Updated May 19, 10:36 a.m.

House Bill 3210 failed on a vote of 59-40 against the measure even after House Speaker Jeff Hickman, R-Fairview, held the vote open for more than two hours Wednesday night to fix what he called a “health care disaster.” Republicans blaming Democrats for the bill's failure.

It’s now the final month of the legislative session, and lawmakers have less than four weeks to pull off a budget deal to close a $1.3 billion shortfall for the fiscal year that begins July 1. Will they get it done?

“Yes,” state Sen. Mike Schulz, R-Altus, told reporters Thursday. “I want to go home.”

Oklahoma's constitution requires the legislature to adjourn on the final Friday in May. Lawmakers have discussed wrapping up their work a week early, which they’ve done every year since 2012.

Hospital and nursing home administrators urged the Oklahoma legislature Wednesday to increase the tobacco tax by $1.50 per pack of cigarettes as way to stave off a proposed 25 percent cut to the Medicaid reimbursement rate.

They also announced support for a plan to expand the state’s Insure Oklahoma program and accept federal healthcare dollars.

Eastern Oklahoma Medical Center CEO Mike Carter says a cut to the Medicaid reimbursement rate would devastate his hospital.

Senate President Pro Tem Brian Bingman, R-Sapulpa, says there's growing support in his Republican caucus for a plan to rebalance Oklahoma's Medicaid population to trigger an infusion of federal funding.

“And again, it comes down to how do we pay for our share of state dollars?” Bingman said.

He told reporters Thursday the potential for 25 percent cuts to Medicaid providers could significantly affect Oklahoma's health care system.

A bill that would have taken over 100,000 Oklahomans off Medicaid failed to pass through a Senate committee on Monday. House Bill 2665, written by state Rep. Doug Cox, R-Grove, and state Sen. Brian Crain, R-Tulsa, aimed to remove “able-bodied adults” from Medicaid but would have left the aged, blind, disabled and children with coverage.

The Oklahoma Health Care Authority announced Tuesday its plans to cut reimbursement rates for Medicaid providers by 25 percent as a result of the state’s budget shortfall for the upcoming fiscal year.

The cuts, which must first go through a series of public hearings over the next 60 days, would affect all provider types, including hospitals, physicians, pharmacy, durable medical equipment suppliers and nursing facilities, according to a news release from the Health Care Authority.

At the insistence of state lawmakers, the Oklahoma Health Care Authority is exploring cost-saving options that could lead to partial privatization of the state’s $2.4 billion Medicaid program for aged, blind and disabled people.

The state tried that once before, and it didn’t work out. Costs escalated, companies dropped out, and the state pulled the plug. Supporters of the new effort predicted it might turn out better because of improvements in managed-care practices.

The operator of an Oklahoma mental health care facility has been sentenced to five years in prison for allegedly billing fraudulent claims to the Oklahoma Health Care Authority.

Oklahoma Attorney General Scott Pruitt's office announced the sentence Wednesday for John Michael Doneti, a licensed professional counselor who ran Central Oklahoma Behavioral Health Services, LLC. Doneti was also sentenced to five years of probation and ordered to pay $194,000 in restitution.

State and tribal leaders in Oklahoma are exploring opportunities for a federal waiver that could mean health insurance for more than 40,000 low-income uninsured tribal members in the state.

While state leaders oppose a Medicaid expansion offered under the federal health care law, this latest idea to expand Insure Oklahoma would involve no state funds.

While some Republican-led states are exploring whether to expand Medicaid to include more low-income residents, Oklahoma's GOP leaders remain steadfastly opposed to the idea.

The head of the Oklahoma Health Care Authority says there is no effort underway to seek a Medicaid expansion or even develop an Oklahoma-specific plan for seeking available funding.

Indiana recently received approval to expand Medicaid through a state-run program, making it the 128th state to do so and the 10th with a Republican in the governor's mansion.

Starting this weekend, an estimated 446,000 low-to-middle-income Oklahomans can sign up for government-subsidized health insurance for 2015 through the online marketplace established by the Affordable Care Act.

The 2015 open enrollment period begins Saturday, Nov. 15, and ends Sunday, Feb. 15. Federal officials and ACA advocates are encouraging people to complete their applications by Dec. 15 to avoid ensure their coverage begins on Jan. 1.

A recent national survey by the Henry J. Kaiser Family Foundation in Washington, D.C., showed that 89 percent of uninsured people were not aware that open enrollment begins this month.

“It’s an unfortunate continuation of a trend that’s been going on for quite a while now,” Kaiser Foundation Senior Fellow Karen Politz said in a briefing with reporters. “People really aren’t that familiar with what’s in the ACA, whether it will help them, and what the rules are.”

The operator of some Oklahoma dental clinics has agreed to pay more than $5 million to settle allegations that it submitted false Medicaid claims.

Federal and state prosecutors said Friday they had alleged that Ocean Dental, which operates clinics throughout the state, submitted false Medicaid claims for work that was either never performed or billed at higher rates than allowed.

Healthcare advocates asked lawmakers Tuesday to find solutions to reduce Oklahoma’s uninsured population -- whether it be accepting Medicaid expansion under the Affordable Care Act or via its own state funded alternative.

The comments were made in the Appropriations and Budget Subcommittee on Public Health during a combination of interim studies related to healthcare funding, access and the uninsured.

The studies were requested by Reps. David Perryman, D-Chickasha; Emily Virgin, D-Norman; Joe Dorman, D-Rush Springs; Chuck Hoskin, D-Vinita.

The Oklahoma Health Care Authority Board approved a request to the legislature to increase funding by $275 million for next fiscal year. Of that increase, nearly 60% would fund the agency’s priority items and maintain their existing program in fiscal year 2016.

The increase would add to the base funding of around $953 million in state funds.