Press Release

April 20, 2020
For Immediate Release 

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

Jonathan Cannon, Sr. Director of Communications
405-517-1797  |  jonathan.cannon@okhca.org 

 

OHCA Submits Healthy Adult Opportunity Demonstration Waiver for CMS Approval

OKLAHOMA CITY — The Oklahoma Health Care Authority today announced its submission of the federal Healthy Adult Opportunity demonstration waiver to the Centers for Medicare & Medicaid Services with a requested effective date of July 1, 2021. The demonstration opportunity gives the state flexibility to design an Oklahoma plan to bring more access to care to more Oklahomans. 

“This is another step in our SoonerCare 2.0 plan to reduce the number of uninsured Oklahomans and improve health outcomes while still maintaining fiscal responsibility for Oklahoma taxpayers,” said Gov. J. Kevin Stitt. “Even during this time of immense change due to the COVID-19 pandemic, it is important to move forward in our efforts to create a healthier Oklahoma.” 

OHCA submitted a state plan amendment earlier this year to expand Medicaid to Oklahoma adults ages 19-64 with income less than 133% federal poverty level ($16,970 annual income for an individual; $34,846 for a family of four), who do not otherwise qualify for Medicaid. That expansion will go into effect July 1, 2020. The HAO demonstration waiver applies only to this expansion population and does not affect current Medicaid members, although they may see benefits as the state reinvests its shared savings from the changes back into the program.

“Maximizing federal funding allows the state to invest more in services such as treatment for opioid addiction and improved rural health care," said OHCA CEO Kevin Corbett.  

The HAO demonstration waiver allows the state more flexibility in how it administers the plan for the expansion population of healthy adults — such as incentive programs for healthy behaviors, added benefits such as behavioral health offerings, the ability to address social health determinants, and more. The state is also using this time of innovation in its health care system to move from a traditional fee-for-service model toward outcome and value-based care. 

To enhance alignment between Medicaid policies and the commercial health insurance market, individuals in the expansion population will be asked to invest in their health via community engagement requirements and nominal monthly premiums after July 1, 2021. Premiums are tiered based on family income at $0, $5 or $10 monthly for an individual or $0, $7.50 or $15 for families. 

“Research shows that individuals who are employed, volunteer in their communities or pursue educational or vocational activities are generally healthier,” Corbett said. “Incentivizing these engagement activities can lead to enhanced psychological well-being and reduce the negative health impacts of economic hardship.” 

Groups such as pregnant women and those seeking treatment for severe mental illness or substance use disorder are exempt from these community engagement requirements. There are other exemptions as well. 

Public comments on the HAO demonstration waiver were accepted in four virtual meetings with more than 600 participants in addition to online submissions. In response to public feedback, changes were made to the waiver submission such as eliminating coverage wait times in certain instances and more protections for the American Indian and Alaska Native populations.  

“Thank you to everyone who has participated in the public comment process for the HAO waiver,” Corbett said. “Your feedback helps create policy that will move the state toward healthy outcomes.” 

Read more about SoonerCare 2.0, including the HAO demonstration waiver submission, at https://www.okhca.org/soonercare2/

 
 

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About the Oklahoma Health Care Authority

The Oklahoma Health Care Authority 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 800,026 Oklahomans enrolled in OHCA’s programs. The agency contracts with a network of approximately 60,000 providers. For more information, visit www.okhca.org or www.insureoklahoma.org.