Agency submits Medicaid waiver to impose work requirements, charge premiums

Apr. 21--The Stitt administration is moving forward with plans to charge Medicaid premiums and impose work requirements on Medicaid recipients who could be newly eligible for coverage as soon as July 1.

The Oklahoma Health Care Authority on Monday submitted to the federal government the state's Healthy Adult Opportunity waiver application.

If approved by the Centers for Medicare and Medicaid Services, the waiver could allow state health officials to implement Gov. Kevin Stitt's vision for Medicaid expansion next summer.

The health care agency received more than 2,000 emails asking questions about the waiver, suggesting changes or providing comment on the proposal, said Deputy State Medicaid Director Traylor Rains. Roughly 640 people attended at least one of four virtual meetings held for the agency to take public comments.

Critics of the governor's Medicaid expansion plan, dubbed SoonerCare 2.0, slammed the Stitt administration for not pausing the public comment period while the coronavirus epidemic rages.

"This is another step in our SoonerCare 2.0 plan to reduce the number of uninsured Oklahomans and improve health outcomes while still maintaining fiscal responsibility for Oklahoma taxpayers," Stitt said in a statement. "Even during this time of immense change due to the COVID-19 pandemic, it is important to move forward in our efforts to create a healthier Oklahoma."

The Trump administration's Healthy Adult Opportunity waivers let states tailor their Medicaid expansion plans. The Health Care Authority anticipates receiving approval by November. If approved, the changes outlined in the waiver would take effect July 1, 2021, and would only affect newly eligible Medicaid beneficiaries who would qualify under an expansion of Medicaid.

Stitt has talked about expanding Medicaid on July 1, 2020, plans that appear undeterred by current events.

The waiver seeks to impose monthly insurance premiums of $10 a month for individuals or $15 a month per family, with some exceptions. The waiver also seeks to phase in community-engagement requirements that would require participants to work, volunteer or go to school for at least 80 hours per month.

One of the more controversial aspects of the application, Rains said the community-engagement requirements were not changed after the public comment period. Critics have said the work requirements are likely to be challenged by a lawsuit, which could land the state in a lengthy and expensive court battle.

The Health Care Authority did alter the managed care part of its application in response to some public comments received. The final application clarified newly eligible Medicaid recipients would be covered under the state's existing managed-care system as opposed to being covered by an outside company. Managed care aims to cut Medicaid costs while improving outcomes, which detractors say defeats the purpose of the program.

Oklahoma voters will have another option when State Question 802 comes up for a vote on June 30. SQ 802 seeks to add straight Medicaid expansion, with no work requirements or premiums, to Oklahoma's constitution.

If the state question passes, the Healthy Adult Opportunity waiver and SoonerCare 2.0 essentially would be null and void.

The Healthy Adult Opportunity waiver would limit who could receive Medicaid benefits. With the waiver, an estimated 144,285 Oklahomans would receive health coverage in the first year, compared with 151,879 people receiving benefits under a traditional expansion, according to estimates from the Health Care Authority.

State leaders have not yet decided how to pay for Medicaid expansion.

The state's share of the expansion is expected to increase by $50 million to $200 million next year because of increased unemployment due to the coronavirus, Stitt said. The state would have to cover the 10% of expansion costs not covered by the federal government.

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