Precarious Prognosis: Oklahoma Health Care Authority Awaits Policy Guidance on Health Care

Article excerpt

U.S. Supreme Court rulings on the Affordable Care Act leave the Oklahoma Health Care Authority in a precarious balancing act.

Although states now have the option to opt out of the ACA's Medicaid expansion, the authority must still prepare to absorb up to 200,000 additional users into its SoonerCare program while it awaits policy guidance from Gov. Mary Fallin and the Legislature.

Luckily, the OHCA has a history of adapting to change, Director of Planning and Development Buffy Heater told several hundred attendees at Thursday's OHCA Board Retreat at Tulsa's Hyatt Regency Hotel.

In some areas, like information processing, the authority has already scored successes preparing for federal mandates.

Chris Dees, an OHCA eligibility specialist in its Information Services Data Integrity Unit, said SoonerCare's 2-year-old online enrollment system handled 57 percent of all applications in July. His department is working on upgrades along the ACA timeline while aligning its database to meet not only other SoonerCare needs, but also those of other state agencies and organizations.

But in other areas, the authority still faces formidable obstacles. If the state opts in with the federal Medicaid expansion at Jan. 1, 2014, the current distribution of SoonerCare's 40,825 providers would leave nine counties without enough coverage capacity if just 57 percent of the state's adults and children enter that state program, according to Becky Pasternik-Ikard, OHCA's deputy state Medicaid director and SoonerCare operations director.

State Medicaid Director Garth Splinter said the ACA expansion plan requires that the OHCA provide the 10 following benefits:

* Outpatient services.

* Emergency services.

* Hospitalization.

* Maternity and newborn care.

* Mental health services.

* Prescription drugs.

* Rehabilitative and habilitative services and devices.

* Laboratory services. …