Federal and state funding for healthcare services remains uncertain

Nov. 13--As the state Legislature tries to resolve the state budget deficit and the threat of more cuts to state agencies looms, federal Children's Health Insurance Program funding, which funds SoonerCare, has still not been renewed and losing it could be another serious blow to healthcare in Oklahoma.

The program was created to provide healthcare coverage for uninsured children who don't qualify for Medicaid and covers 8.9 million children nationwide. In Oklahoma, CHIP and Medicaid funding are combined under Soonercare, which covers 804,569 Oklahomans, 533,653 of whom are children. As of August, 12,115 adults and children in Carter County were enrolled in SoonerCare according to the Oklahoma Health Care Authority.

Oklahoma Policy Institute Policy Analyst Carly Putnam said lawmakers are more focused on immediate budget concerns and have not addressed the CHIP issue directly yet.

"I think CHIP is not on the Legislature's radar right now," Putnam said. "The Legislature has, at this point, maybe two weeks to stop a runaway train. I think they're trying to salvage the more immediate disaster. If they manage to pull something together in the next week, it might look different than House Bill 1054 did, so it's going to depend on what does eventually shake out."

Remaining CHIP funding for Oklahoma will not run out until April of next year. Putnam said the Oklahoma Health Care Authority announced changes could happen as early as January at a meeting last week.

"Without congressional action, two CHIP sub-cuts may be facing eligibility terminations by January 31," Putnam said. "It would be the Soon-to-be Sooners program and the CHIP-funded dependent coverage through Insure Oklahoma's employer-sponsored plan."

But there are still more pressing concerns. The Oklahoma Health Care Authority announced November 3 that the Oklahoma Department of Human Services plans to cut two Medicaid waiver programs, the ADvantage program and Adult In-Home Services. ADvantage helps elderly and disabled adults receive care at home, while Adult In-Home Support does the same for adults with mental disabilities.

"The OHCA expects the number of members living in nursing facilities will increase with the programs' elimination, resulting in a significant impact on the OHCA budget," OHCA stated via press release. Preliminary numbers compiled by OHCA show that the potential one-year state share impact on OHCA's budget ranges from $124 million ($456.6 million total) if 50 percent of ADvantage members move into nursing facilities to $247 million ($913 million total) should all ADvantage members move into facilities."

Putnam said the programs are expensive, but crucial.

"Roughly 25,000 individuals get in-home services through those programs and right now they're on the chopping block as of December 1," Putnam said. "I think there's going to be an effort to spare them, but right now there's not a lot that can be cut."

Good Shepherd Clinic's executive director Teresa Myers said the clinic, a charity clinic that recently expanded its operations, started accepting SoonerCare patients to help ease the burden on other primary care providers in town last year.

"For the last 20 years we've seen people who have no insurance, who are at 200 percent poverty level and below," Myers said. "This allows more access. We're in a professional health care shortage area in Carter County."

Carter County isn't alone. A map produced by the Office of Primary Care & Rural Health Development this year designated all but four Oklahoma counties as Health Professional Shortage Areas. Myers said lack of access has a few causes.

"It's hard to attract providers here," Myers said. "A lot of the state is Medicaid recipients. You can't get rich, and it's difficult. Most of Oklahoma is rural, and it's harder to provide healthcare providers there. There's limited access for Medicaid. There's a community health center in Tishomingo, but that's 45 minutes away for Carter County. "

If funding decreases and coverage shrinks, Myers said she anticipates Good Shepherd, the only full-time charity clinic within about 100 miles, will be seeing more patients.

"This is just me speculating," Myers said. "But if CHIP is cut, we'll see more patients coming through our doors because we fill that gap. We have a little over 2,000 patients already, about 10 percent are Medicaid recipients. We already have people coming from Jefferson County, Bryan County, Garvin County. But we're here to help, and if people do lose their coverage, as long as we have the space and appointments available, they are welcome."

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