August 23, 2019

Media Contact:
Katelynn Burns, Sr. Public Information Representative
405-522-7266  |  katelynn.burns@okhca.org 

SoonerCare provider rates set to increase 

OKLAHOMA CITY – The Oklahoma Health Care Authority board voted to approve a five percent rate increase to most SoonerCare (Oklahoma Medicaid) providers during their Aug. 21 board meeting.

The rate increase, mandated by Senate Bill 1044, is effective Oct. 1, contingent upon approval by the Centers for Medicare & Medicaid Services (CMS).

“A goal of the OHCA is to pay providers competitive rates for services for our SoonerCare members. The rate increase mandated by SB1044 will help us sustain and continue to build our network of providers across the state,” said OHCA CEO Kevin Corbett. “A strong provider network ultimately benefits our SoonerCare members by improving access to care.”

Per SB1044, the rate increase excludes: services financed through appropriations to other state agencies; Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS); non-emergency transportation capitation payments; services provided to Insure Oklahoma (IO) members; payments for drug ingredients/physician supplied drugs; Indian Health Services/Tribal/Urban Clinics (I/T/U); Federally Qualified Health Centers (FQHCs); and Rural Health Centers (RHCs).

The five percent rate increase will put SoonerCare physician rates at 93.63% of the Medicare physician fee schedule. SoonerCare physician rates have not exceeded 90% since mid-2014 when state budget reductions resulted in a 7.75% reduction to rates, dropping them to 89.25% of Medicare.

For the remainder of State Fiscal Year (SFY) 2020, the rate increase will have an estimated budget impact of $62.8 million of which $21.3 million is state share. The estimated budget impact for SFY 2021, a full year with the increase, is about $85.65 million; of which $28.3 million is state share.

 -30-

About the Oklahoma Health Care Authority

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 809,162 Oklahomans enrolled in OHCA’s programs. The agency contracts with a network of 54,643 providers. For more information, visit  www.okhca.org  or  www.insureoklahoma.org.