December 10, 2015

OHCA Contacts: Jo Kilgore - (405) 522-7474,  Jennie Melendez- (405) 522-7404   

OHCA board approves provider rate cut amidst difficult budget year

The Oklahoma Health Care Authority (OHCA) board approved a three percent across-the-board provider rate reduction at their Dec. 10 board meeting.  

CEO Nico Gomez advised members of the board in November that the agency was advised not to expect any additional state dollars in state fiscal year 2017, and that a reduction would be needed in order to submit a balanced budget for state fiscal year 2017. 

OHCA estimates it will need an additional $37.5 million state dollars over the current year’s base appropriation to operate the program as it is today. This is due in large part to a decline in federal matching dollars for a second consecutive year to a level not seen since the mid-1980’s, and a conservative estimate of 1 percent growth to cover increased enrollment, utilization and medical inflation.  

The reduction will be effective January 1, 2016. OHCA will also reduce what they pay for nursing home Medicare Part A coinsurance and deductibles on crossover claims from 75 to 20 percent.

“Though I wish provider rate reductions weren’t necessary, we believe that the responsible action to take is to spread the impact over a 17-18 month period, as opposed to requiring a deeper cut over a 12-month fiscal year,” said Gomez. “By taking action now, we hope to lessen the impact.” 

Rate reductions will not include federally qualified health centers, rural health centers, complex rehabilitation technology products and services, SoonerCare services that are funded by other state agencies, Insure Oklahoma, or Health Access Networks. 

The Oklahoma Health Care Authority (OHCA) administers two key health programs for the state. The first is SoonerCare, Oklahoma’s Medicaid program. SoonerCare works to improve the health outcomes of Oklahomans by ensuring that medically necessary benefits and services are responsive to the health care needs of our members. Qualifying Oklahomans include certain low-income children, seniors, the disabled, those being treated for breast or cervical cancer and those seeking family planning services. The second program OHCA operates is Insure Oklahoma, which assists qualifying adults and small business employees in obtaining health care coverage for themselves and their families. OHCA strives to educate and engage our current 827,118 members regarding personal responsibilities for their health services utilization, behaviors, and outcomes in partnership with a state-wide network of 44,288 providers. For more information, visit www.okhca.org or www.insureoklahoma.org.