Claremore Daily Progress

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May 8, 2013

Feds say Insure Oklahoma program must change

OKLAHOMA CITY —

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 said this week, 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 Tuesday 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.”

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