Problems possibly persist with privatized OK managed care

OKLAHOMA CITY (KFOR) – It has been nearly two years since the state attempted to privatize managed care, and since then, there have been many allegations of missed payments and wrong reimbursements.

On Thursday, Oklahoma Attorney General Gentner Drummond requested an audit of the Oklahoma Healthcare Authority.

The AG's office says the letter to Inspector Cindy Byrd is based on provider complaints and OHCA's repeated failure to respond adequately to the AG's formal inquiries about the state's contracted managed care organizations, MCOs Humana, Aetna, and Oklahoma Complete Health.

Drummond wrote in the letter, "Oklahoma's second experiment with managed care Medicaid is failing to deliver on its promises. Providers are reducing staff. Patients are being denied essential care. Out-of-state corporations are controlling access to critical services without accountability…"

Oklahoma Health Care Authority audit requested by AG Drummond

In it, he claimed that the person who oversees OHCA, Clay Bullard, has admitted there were issues that needed to be fixed. But, OHCA failed to fulfill its oversight obligations regarding the MCOs.

In January, Bullard told lawmakers that they had depleted their reserves, and then he requested a historic nearly $500 million for their budget. Bullard then suggested that the state didn't need to have Medicaid as a program. Thus, lawmakers' conversation began about possibly making cuts to Medicaid.

There have been several efforts, one of which could be on the ballot later this year, that could end up cutting people from Medicaid.

According to Drummond's letter, "the resulting erosion of rural health care infrastructure and the denial of essential Medicaid services to Oklahoma's most vulnerable residents raise serious questions about OHCA's stewardship of public funds and its compliance with applicable state and federal law."

Drummond states in part, "Providers are reducing staff. Patients are being denied essential care." And goes on to write, "OHCA leadership highlights the MCOs' numbers to deny that these

problems persist."

News 4 reached out to OHCA about several of the allegations.

Is it true that the three MCO's are not making payments on time?

"No. For February 2026 (an average month), MCOs processed over 884K medical claims with 98.53% of claims within 14 days and 580K pharmacy claims with 99.99% of claims within 14 days," responded a spokesperson with OHCA.

Bullard has suggested taking Medicaid Expansion out of the State Constitution. Is it because there are a lot of problems being found with managing Medicaid and the MCO's specifically?

"No, this was suggested to have financial flexibility long-term. It's also important to note that if that passes the ballot by voters, it is only removed from the state constitution if the federal government drops their 90% match," said OHCA.

Drummond says you all acknowledged the issues that need to be fixed. What are those issues?

"We had a clerical issue on one rule and have since fixed that issue," stated OHCA.

Bullard asked for nearly $500 million in the budget request in January. Could improperly managed MCO's be a reason why so much money is needed?

"No. This amount was requested to provide stability to the agency, meet increased utilization rates, the rural health transformation fund, HR1 requirements, and an extra week of claims (happens every 6 years). I've attached our FY27 budget request document for you to review," stated OHCA.

Lawmakers had a chance to respond to the allegations from Drummond about the improperly managed care.

"I haven't looked at everything. But I think it's worth looking to make sure that folks who need access to insurance that they're getting it, especially those who are Medicaid recipients in Oklahoma. So I'll look forward to looking into it more," said Rep. Cyndi Munson (D-OKC).

"The way that we structured the program. Of course, some of those provisions have changed with the way the big, beautiful bill was structured, and so, you know, we're going to be working through that in the coming years," said House Speaker Kyle Hilbert (R-Bristow).

"But as far as the audit goes, absolutely another set of eyes on that, I think, is always a good thing. We're still kind of in the early stages of what we're working on through the new director of the health care authority. It's kind of unfolding," said Senate Pro Tempore Lonnie Paxton (R-Tuttle).

State Auditor Cyndi Byrd has a long list of audit requests that she has been requested to do. It's unknown how long it would take before anything is revealed from this one.