Still in the early stages of the process, Stitt's push to privatize Medicaid by hiring a for-profit company to manage the program's spending is already facing pushback from some members of his own party.
Care for the state's aged, blind and disabled population also would be phased in over time.
"Engaging providers through a managed care organization will help us achieve our goal of ensuring Oklahomans receive improved access and quality care," Stitt said in a statement. "While we do expect cost savings to follow the improved health outcomes, the state will continue to be laser-focused on helping Oklahomans."
Managed care is an approach to health insurance coverage that seeks to maximize health care quality while cutting costs. Critics say the two goals are diametrically opposed to each other.
Managed care companies are essentially health care middlemen that drive down Medicaid costs, which provides more budget consistency for states. In
Details of the privatization push have been limited, leaving lawmakers and health care leaders to wonder what exactly is in store for the future of
Some don't appreciate being left in the dark.
"I think the Legislature's been left out of the process," said Rep.
A spokeswoman for the
"We have proactively reached out to legislators to keep them up-to-date throughout the process, and we will continue to do so," spokeswoman
What is managed care?
Under a privatized system, the state gives cash payments to for-profit companies that then cover doctor's visits, prescriptions, long-term care or any other eligible costs.
The fixed payments incentivize managed care companies to cover only the most affordable and effective treatments and encourage patients to be proactive in seeking necessary medical care.
The idea is that if patients get more coordinated care, like regular primary care visits, more severe and potentially costly health problems can be caught early or prevented altogether.
If the companies succeed in driving down costs, they profit from the state's payments.
Asked what that means for patient care, McEntire, who chairs the House Appropriations and Budget Subcommittee on Health, said that's the million-dollar question.
The level of care can vary based on the managed care organization that's hired and how the program is structured, he said. There's also the chance that some of the more costly elements of care won't be covered.
"When you put in a profit motive, there's always the chance that a treatment gets denied or a referral doesn't happen," he said.
From the patient perspective, managed care operates similar to health insurance plans companies offer their employees.
Since the 1990s,
In 1995, the
SoonerCare Plus ended in 2004 after the managed care organizations sought a nearly 20% rate increase the state could not match.
New federal managed care regulations are extensive and will allow the
"Managed care in 2020 looks very different than it did in the early 2000s," she said.
A more recent push to privatize care for some of the state's Medicaid beneficiaries ground to a halt in 2017 due to a lack of funds to cover the upfront costs. Spurred by some lawmakers, the
A Legislature divided
The governor's push to privatize the state's Medicaid program could set up a fight between his administration and state lawmakers.
Since Stitt assumed office, rumors have swirled that he wanted to implement managed care, said Sen.
Managed care was a big part of the health care debate in the spring when Stitt asked lawmakers to fund his SoonerCare 2.0 proposal. In return for an increase in fees assessed on some
In the end, Stitt appeared to get cold feet about expanding Medicaid in the midst of a global pandemic that is likely to increase the number of people who qualify for Medicaid benefits.
"I have tried for two years to meet with the governor to understand why he thinks this is a good idea, and for two years, that meeting was denied," McCortney said. "I finally got the meeting. While the meeting was great, three days later I got a call from the governor's office saying, 'no, the governor doesn't really want to talk about this anymore.'"
A pharmacist, Standridge said he anticipates the change will be costly for the state and not conducive to quality care.
Standridge said he would stop being so critical if a majority of the Legislature was on board with the decision. But by his estimation, three-fourths of legislative
"Through the budget process, I say we just don't fund it because it's going to cost a lot the first year and a ton more the years after that," he said. "I think that's the only way to do it unless the governor reassesses between now and February."
Details of the costs will become more clear after the
Standridge worries a managed care company would agree to oversee the Medicaid population for a specific price, but would ask the state for more money in later years -- essentially eliminating any possible cost savings.
Republican legislators, who control the
Senate Majority Leader
In a statement provided by the
"We must look at how every other state that has expanded Medicaid was able to control costs, as well as ensure the best health outcomes -- they contracted with insurance companies to help provide access to care and continued care," David said.
Healthier Oklahomans is the end goal, she said.
More than 40 states use Medicaid managed care, although the programs can vary from state-to-state.
Managed care companies also don't have to pay out Medicaid claims as quickly as the state, which could create cash flow problems for small, rural hospitals and independent physicians' practices, Davis said.
Typically, the state covers those claims within 14 days, but commercial insurance companies have 45 days to pay, she said.
Davis laid out her concerns in a 13-page letter submitted to the
Efforts to improve the health of Oklahomans and control expenses would be best accomplished by building on the strengths of the
"There is no clear evidence that outsourcing to MCOs (managed care organizations) saves states money or improves outcomes," Davis wrote. "Medicaid MCOs make billions in profits each year, and add administrative costs in the tens of billions. And that money leads to powerful influence over state governments."
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