Whether Oklahoma expands Medicaid fully through the ballot box or partially through the legislature, it’s likely a private company will be hired to run it.
Oklahoma’s Health Care Working Group spent hours this week learning the ins and outs of managed care organizations, which take a set per member, per month payment for delivering Medicaid services.
Clay Farris with consulting firm Mostly Medicaid said the benefits for states aren’t just in budget planning.
"Transferring the risk, just conceptually, moving from all of the risk being on the state and federal taxpayer to some of it being on the private sector," Farris said.
Farris said managed care organizations account for around one-fourth of Medicaid spending in the U.S., and they now cover 82% of children and 49% of the aged, blind or disabled enrolled in Medicaid.
"I’ll still see the opposition thinking, 'Oh, well we can’t trust managed care with this population or that population.' Well, other states have been trusting managed care with these populations more and more," Farris said.
Farris, however, said states need to exercise strict oversight of managed care organizations if they want to see health improvements, especially in rural areas.
Health care working group Co-chair Rep. Marcus McEntire pointed out Oklahoma tried managed care about 20 years ago. That collapsed when one of two health plans pulled out of the arrangement. Farris said that problem can be fixed.
"It’s unusual for a plan to do it, because once they do it, they’ve burned a bridge and states hate them, especially that particular state. That would be my sort of initial answer without research, is get more plans next time," Farris said.
