An Oklahoma program that uses Medicaid funding to provide health insurance to 30,000 low-income Oklahomans must change in order to keep its funding, the federal government has said, even as a legislative plan that tries to make those changes seems stalled.
The Insure Oklahoma program needs a renewed waiver to use Medicaid funding to help some people pay for private insurance, which the Centers for Medicare and Medicaid Services denied earlier this year. CMS sent a letter on May 7 explaining the waiver’s denial to Oklahoma’s Health Care Authority, which runs the Insure Oklahoma program.
Without the waiver, Insure Oklahoma will stop operations at the end of the year. The letter from CMS Director Cindy Mann cited the federal Patient Protection and Affordable Care Act, which provides funding to states to expand their Medicaid programs under certain rules.
“The new law will mean that an extension of the Insure Oklahoma program without any changes is not possible,” Mann wrote in a letter addressed to Health Care Authority CEO Nico Gomez. For example, Mann said, the current program includes enrollment caps that the law prohibits.
Gov. Mary Fallin rejected the funding for the Medicaid expansion last year, saying it was too expensive for the state and the country. In Oklahoma, almost 200,000 people would be newly Medicaid-eligible with the expansion.
Several Republican-controlled states, including Oklahoma, are looking into ways to accept the expansion funds and help more people become insured without technically expanding Medicaid itself. The Health Care Authority expects recommendations from Utah-based consulting firm Leavitt Partners in June.
The Arkansas Legislature last month passed a broad plan, similar to Insure Oklahoma, to use the money to buy private health insurance, a practice called premium assistance. CMS has tentatively approved the idea.
In her letter, Mann suggested Oklahoma look into similar options, adding that, “given Oklahoma’s history of using Medicaid premium assistance to provide coverage options to Oklahomans, we would welcome working with you on such a model, consistent with our guidance.”
Two Republican legislators, Rep. Doug Cox and Sen. Brian Crain, are working on such a plan. It would build off of Insure Oklahoma’s model to help insure 150,000 people with incomes under 138 percent of the federal poverty line. The draft bill also requires recipients to at least be looking for a job and pay modest co-pays.
But both of the bill’s sponsors told The Associated Press they have no hope of advancing the proposal without support from the governor and the Legislature. Fallin hasn’t publicly stated her position on the idea.
“I will tell you there’s starting to be some talk of doing an all-Oklahoma plan, not to accept any federal money, just use Oklahoma tax dollars,” Cox, an emergency room physician from Grove, said.
That idea would use $50 million from the state’s tobacco tax, he said, to help 12,000 people get insurance.
“Versus the Cox-Crain plan, which would use zero Oklahoma tax dollars for at least three years to cover 150,000 people,” Cox said. “At this point, unless the governor steps up, I think there’s very little chance.”
Fallin spokesman Alex Weintz again declined to give Fallin’s position on the plan Wednesday. He said Insure Oklahoma would have continued working just fine if CMS had extended the waiver.
“Insure Oklahoma expiring is not the fault of the governor or the Oklahoma Legislature or anybody else except President Obama and his administration,” Weintz said. “They can say whatever else they want. They can sign it with a smiley face and send us flowers. The bottom line is the waiver that Insure Oklahoma needs to exist is being revoked.”