This week, our In Focus section reviews a new Oklahoma law to implement Medicaid managed care by October 1, 2023. The law, signed by Governor Kevin Stitt on May 26, 2022, requires the state to issue a request for proposals and to award at least three Medicaid managed care contracts to health plans or provider-led entities like accountable care organizations.
Provider-led entities would receive preferential treatment, with at least one targeted to receive a contract. However, if no provider-led entity submits a response, the state will not be required to contract with one.
Goals of the legislation include:
- Improve health outcomes for Medicaid members and the state as a whole;
- Ensure budget predictability through shared risk and accountability;
- Ensure access to care, quality measures, and member satisfaction;
- Ensure efficient and cost-effective administrative systems and structures; and
- Ensure a sustainable delivery system that is a provider-led effort and that is operated and managed by providers to the maximum extent possible.
Plans would provide physical health, behavioral health, and prescription drug services. Covered beneficiaries would include traditional Medicaid members and the state鈥檚 voter-approved expansion population, but not the aged, blind, and disabled population eligible for SoonerCare.
Plans will need to contract with at least one local Oklahoma provider organization for a model of care containing care coordination, care management, utilization management, disease management, network management, or another model of care as approved by OHCA.
Oklahoma will also issue separate RFPs for a Medicaid dental benefit manager plan and a Children鈥檚 Specialty plan.
Background
Oklahoma currently does not have a fully capitated, risk-based Medicaid managed care program. The majority of the state鈥檚 more than 1.2 million Medicaid members are in SoonerCare Choice, a Primary Care Case Management (PCCM) program in which each member has a medical home. Other programs include SoonerCare Traditional (Medicaid fee-for-service), SoonerPlan (a limited benefit family planning program), and Insure Oklahoma (a premium assistance program for low-income people whose employers offer health insurance). Prior efforts to transition to Medicaid managed care have encountered roadblocks, starting in 2017 with a failed attempt to move aged, blind, and disabled members to managed care.
More recently, in June 2021, the Oklahoma Supreme Court struck down a planned transition of the state鈥檚 traditional Medicaid program to managed care, ruling that the Oklahoma Health Care Authority does not have the authority to implement the program without legislative approval.
Contracts had been awarded to Blue Cross Blue Shield of Oklahoma, Humana, Centene/Oklahoma Complete Health, and UnitedHealthcare. Centene/Oklahoma Complete Health also won an award for the SoonerSelect Specialty Children鈥檚 Health Plan program, covering foster children, juvenile justice-involved individuals, and children either in foster care or receiving adoption assistance.
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