April 10, 2017
OHCA Contacts: Jo Stainsby - (405) 522-7474, Cate Jeffries - (405) 522-5616
OHCA eyes provider rates and elimination of benefits and services to balance budget
Optional benefits for SoonerCare members along with provider rate
reductions up to 25 percent are being considered as the Oklahoma Health Care
Authority (OHCA) prepares for its state fiscal year 2018 appropriation.
In years past, SoonerCare (Oklahoma Medicaid) has avoided
eliminating a few of the optional benefits as defined by the federal government
due to the catastrophic outcomes of cutting those benefits. To shore up the
budget in the past, the agency has reduced provider rates and eliminated and
reduced benefits for adults such as sleep studies, perinatal dental, durable
medical equipment purchases, prescription drug limits, etc.
In state fiscal year 2017, the agency was fortunate that its
appropriation was kept relatively flat which allowed the program to continue
without further reductions to benefits or rates. However, with federal funds
shrinking again and state appropriations likely being reduced in SFY18,
protecting optional benefits may no longer be an option for OHCA.
Benefits the agency is evaluating
for elimination or reduction include pharmacy, behavioral health and durable
medical equipment. Programs being evaluated include the breast and cervical
cancer treatment program and the waiver-funded Medically Fragile program and Program of
All-inclusive Care for the Elderly (PACE). Other benefits under consideration
for elimination include private duty nursing services, adult organ transplants,
dialysis, hospice services, physical and occupational
therapy, and speech, hearing and language disorder services. The agency must consider
the projected savings of eliminating each optional benefit versus potential
costs in other areas that may be created by their elimination.
OHCA is beginning its public notification process to reduce
SoonerCare (Oklahoma Medicaid) provider rates. Meetings have been scheduled for
the next few weeks with all of the state’s provider groups beginning Tuesday,
April 11, with the Oklahoma Hospital Association.
“At our March board meeting, we presented budget scenarios
based on state leadership’s request ranging from a 5 percent to a 15 percent
reduction in state appropriations,” said OHCA CEO Becky Pasternik-Ikard. “While
we don’t know our final appropriation, we must be prepared for a reduction. In
order for us to meet our obligations to the federal government, we have to get
the process started.”
It takes OHCA approximately 60
days to implement provider rate changes because of public notification
requirements. To eliminate benefits, OHCA must allow for about 90 days to amend
rules and up to 45 days to receive the governor’s approval under emergency
rulemaking. Due to these timelines, additional action may be needed to achieve
the fiscal year savings in less than 12 months.
A 25 percent rate reduction
will put SoonerCare physician rates at about 65 percent of the Medicare rate. In
addition to physician rates, these reductions will affect all provider types
including hospitals, pharmacy, durable medical equipment suppliers and nursing
“We are looking at reductions that
threaten our health care infrastructure for Oklahoma’s neediest citizens,” said
Ikard. “On the member side, if we have to eliminate the remaining optional
benefits, we will be putting people’s lives at stake. On the provider side,
with a rate cut of this magnitude, we may see more providers, particularly in
the rural areas, close up shop.”
“We realize the potential
consequences, but we recognize we are out of options,” she added.
the meetings with the provider groups, the agency will present the reductions
at the required public meetings listed below.
Advisory Committee (MAC) (open meeting) – May 18
Plan Amendment Rate Committee (SPARC) (open meeting) – May 23
Board (open meeting) – May 25
meetings will be held at the OHCA in the Charles (Ed) McFall Boardroom, 4345 N.
Lincoln Blvd., Oklahoma City. Anyone interested in the SoonerCare program is
encouraged to attend.
information about these meetings, including agendas, will be posted at www.okhca.org/calendar as the
information becomes available.
The Oklahoma Health Care
Authority (OHCA) administers two health programs for the state. The first is
SoonerCare, Oklahoma’s Medicaid program. SoonerCare works to improve the health
of qualified Oklahomans by ensuring that medically necessary benefits and services
are available. Qualifying Oklahomans include certain low-income children,
seniors, the disabled, those being treated for breast or cervical cancer and
those seeking family planning services. The second program OHCA operates is
Insure Oklahoma, which assists qualifying adults and small business employees
in obtaining health care coverage for themselves and their families. Currently,
there are 825,942 Oklahomans enrolled in OHCA’s programs. The agency contracts with a state-wide
network of 45,903 providers. For more information, visit www.okhca.org or www.insureoklahoma.org.