Press Release

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 facilities.

“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.   

Following the meetings with the provider groups, the agency will present the reductions at the required public meetings listed below.

    

Medical Advisory Committee (MAC) (open meeting) – May 18

State Plan Amendment Rate Committee (SPARC) (open meeting) – May 23

OHCA Board (open meeting) – May 25

 

All 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.    

Additional 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.