Governor Kevin Stitt’s plan to outsource management of Oklahoma’s expanded Medicaid program to a for-profit company cleared a procedural hurdle on Tuesday.
The Oklahoma Health Care Authority Board approved on Tuesday spending up to $2.1 billion on contracts next fiscal year with managed care organizations, or MCOs. The 6–3 vote came after public comment from representatives from a handful of health organizations, all of them opposed.
"Proceeding with managed care in Oklahoma will only worsen [the] access to care crisis that especially plagues rural areas in our state," said Dr. Woody Jenkins, representing the Oklahoma State Medical Association.
"There is a direct relation to [MCOs'] practices and the elimination of community pharmacies," said Oklahoma Pharmacists Association Executive Director Debra Billingsley.
"When it comes to the health care outcomes, I wonder what kind of impact this is going to have on this population. If we do have that information available, I've yet to see it," said Victor Clay with the Oklahoma Medical Equipment Provider Association.
"Under Oklahoma's previous experience with managed care, 90% of the dentist providers quit the program altogether," said Oklahoma Dental Association Executive Director Lynn Means.
For awhile, a vote was uncertain. A committee previously advised against pursuing an MCO arrangement, and Vice Chair Alex Yaffe wanted to seek an attorney general’s opinion on the board’s authority in the matter. Counsel advised the board not to hold a vote on that, since it was not on the agenda.
Board member Marc Nuttle said they should vote on the contracts to let OHCA carry out its business.
"A policy debate, ladies and gentlemen, is very dangerous in this environment, to be interjecting ourselves into what the legislature and the governor should be doing," Nuttle said.
Board member Tanya Case told agency CEO Kevin Corbett OHCA doesn’t need to outsource its Medicaid program before she voted no.
"We do not need to manage care through a for-profit MCO. There’s different ways to do this. I wholly support that. I know several months ago, you and I were in absolute, 100% agreement that SoonerCare 2.0 was the way to go. We were going to do it internally," Case said.
Many lawmakers oppose the MCO model. At the end of a budget hearing Monday afternoon, House Appropriations and Budget Health Subcommittee Chair Marcus McEntire (R-Duncan) urged Corbett to work with lawmakers rather than force through managed care.
"We don’t want to be obstructionist here, but we will if we have to be," McEntire said.
OHCA is evaluating proposals from seven MCOs, and plans call for at least three to be chosen. Medicaid expansion takes effect July 1. Stitt and Corbett intend to have managed care in place Oct. 1.
The OHCA Board also on Tuesday approved the agency spending money for contracts with companies to handle Medicaid third-party liability payments, quality review services and dental services.