Medicaid proposal meant to rival Gov. Stitt's plan for managed care faces uncertain future

May 9—Questions loom at the Oklahoma state Capitol about whether the state Senate will challenge Gov. Kevin Stitt's proposed Medicaid overhaul by voting on an alternative plan.

As the Stitt administration continues to move ahead with efforts to outsource care management for most Medicaid recipients to four insurance giants, the Oklahoma House has other plans.

The House passed Senate Bill 131 for the Oklahoma Health Care Authority, which oversees the state's Medicaid population, to provide better care management in-house, as opposed to delegating that work to health insurance companies.

Whether the bill will be heard in the Senate remains to be seen, but pressure is mounting on the Senate to act.

Asked recently about the status of SB 131, Senate Majority Floor Leader Kim David, R-Porter, declined to comment.

A proponent of the governor's third-party managed care plan, David has significant sway in which bills get heard on the Senate floor.

Sen. Jessica Garvin, R-Duncan, the Senate author of SB 131, said managed care conversations are ongoing, but she would like the Senate to vote on the bill.

"I'm not opposed to managed care, really, I'm just opposed to doing it with companies from out of state," Garvin said. "With my professional experience as a nursing home administrator, I work with managed care companies every single day and they've never really been beneficial for patient care."

In contracting with the Health Care Authority, the insurance companies agreed to have a presence and staff in Oklahoma.

With Oklahoma on track to expand Medicaid this summer, Stitt and leadership at the Health Care Authority have been working to implement third-party managed care, in which the agency would contract with insurance companies to directly oversee care for many Medicaid beneficiaries.

Expressing concerns that patient care may deteriorate under the proposed changes, a coalition of hospital leaders and medical providers oppose Stitt's plan, dubbed SoonerSelect.

The Health Care Authority has already contracted with four health insurance companies to oversee medical care and three companies to oversee dental care.

SoonerSelect comes with a $2.2 billion price tag, but Health Care Authority officials have said the costs will be covered through the agency's existing budget.

Stitt believes SoonerSelect will improve care for Medicaid recipients and provide budget consistency for the state after years of increasing Medicaid costs have made the program one of the state's most expensive.

"The governor, the legislature, we have a right to say how that $8 billion is going to be spent, and managed care is the right way to do it," Stitt said. "42 other states do it this way. We're 49th in health outcomes, so Oklahomans elected the wrong person if they just want me to be satisfied being 49th."

Proponents of third-party managed care say health insurance companies have more resources and experience to provide patients more coordinated care, which can help Oklahomans prevent or manage severe and potentially costly health problems

Rep. Marcus McEntire, the Republican author of SB 131, wants the Health Care Authority to implement an internal managed care program to control costs and improve patient care.

SB 131 would require the Health Care Authority to develop "a program that controls costs and improves health outcomes for Medicaid beneficiaries" through additional preventative health screenings and chronic care management.

Medicaid recipients would enroll in a health plan at the office of their primary care physician where the doctor would conduct an annual health and wellness assessment.

On a vote of 73-17, SB 131 passed the House last month with a veto-proof margin.

The bill, which will likely be vetoed if it makes it to the governor's desk, does not explicitly bar the state from moving forward with third-party managed care.

The Health Care Authority estimates SB 131 will cost the agency $263 million annually, largely due to increased staffing and technology needs.

"SB131 purports to direct OHCA to coordinate managed care internally," according to a statement from the agency. "While we have an incredible team at OHCA, we do not have the amount of personnel, the infrastructure or the technology needed to truly coordinate care for SoonerCare members as compared with our partners who have decades of experience producing healthier member outcomes."

In a recent interview, House Speaker Charles McCall, R-Atoka, said he ultimately thinks Stitt will win the policy dispute and the state will implement privatized managed care.

McCall, who voted in favor of SB 131, said legislators believed it was important to have a conversation about the future of health care in Oklahoma. Most House legislators think keeping the Health Care Authority in charge of care management will be better for Oklahomans, he said.

"It's not personal toward the governor at all," McCall said. "I'd hope that the governor would understand and see that lawmakers, their job is to make law and set state policy, and members of the House were just responding to their constituencies."

Instead of advancing SB 131, state lawmakers could opt out of funding SoonerSelect through the state budget process. The contracts with managed care companies are contingent upon funding from the Oklahoma Legislature.

Stitt has implied SB 131 is akin to socialized health care, a response one Republican legislator called a "blatant lie."

After the House passed SB 131 with bipartisan support, Stitt took aim at the Republicans who supported the proposal.

"It is disappointing that in the dead of night, 57 House Republicans voted to grow government and spend $1.2 billion of taxpayer money over 5 years on a one-way ticket to Joe Biden's socialized health care plan in order to please the Oklahoma Hospital Association."

Following Stitt's news release, Rep. Josh West, R-Grove, said he started getting calls from friends and family members wondering why he voted for a "liberal, socialist policy."

Five or six phone calls later, West said he had to try and correct the governor's narrative.

"It reminded me, (Stitt) uses the term all the time 'we're playing D.C. political games,'" West said. "That is something that looked like a press release that one of the members of the federal delegation would put out against a Democrat. Instead, it was my Republican governor putting it out against 57 Republican members who were all getting slammed in their districts."

Socialized health care is when the government operates health care facilities and employs doctors and other health care professionals.

Although Medicaid is a government-run health care program, Oklahoma's Medicaid program doesn't operate hospitals, health facilities, or employ health care professionals. Medicaid just covers the costs of treatment for low-income Oklahomans.

Oklahoma will expand Medicaid on July 1. The Health Care Authority intends for SoonerSelect to take effect Oct. 1.

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