Thread by @CathJSweeney

The Oklahoma Senate Health and Human Services Committee is hearing from the Oklahoma Health Care Authority, which administers Medicaid. I won't really be live tweeting but will share some highlights.

OHCA CEO Kevin Corbett: OHCA's budget request is $210 million — close to 20 percent — over the prior year. "Suffice it so say a large part of that is expansion."

Kevin Corbett: There will be a few savings with partner agencies that will offset some of the cost. For example, we have mental health programs that now all use state funding, but under expansion, we'd get a federal share. "We think the net benefit of that is about $17 million."

Under expansion, adult dental services will expand. Currently, Medicaid covers only extractions. Under expansion, it will cover fillings and other more preventative services. Sen. Paul Rosino notes extractions are an expensive service, and preventative should provide ROI.

Sen. Rob Standridge: We have talked previously about the cost to implement managed care. I'd like to understand what we should anticipate. Do you have a guess on how much we pay per member now?
Corbett: $6,000 per member before expansion.

Standridge: Do we anticipate per member cost staying near $6,000?
Corbett: Yes. The rates established for next year are based on the rates that exist now. Aged, Blind and Disabled population (ABD) will not be under managed care. They're the most expensive. So it should be lower

Standridge: Do we expect cost savings for next year?
Corbett: We don't expect a cost savings for this year, but we do in the future. Tennessee and other states have seen the cost of managed care per member increasing at a slower rate than those that aren't under managed care.

(For the uninitiated, OK Medicaid uses a fee-for-service model. People enroll, the state and feds split an agreed-upon amount for services. X for a checkup, X for an appendectomy etc. Under managed care, they pay a sum for each member to a private company to coordinate care.)

(This would be called managed care, and lawmakers/policy people will refer to it as an MCO, managed care organization. Stitt admin is bringing it through, but other GOP have supported it. However, many GOP, including members of this committee, adamantly oppose it.)

The committee and agency agree — there is "pent-up demand" for expansion coverage. There are a lot of people who will qualify after expansion who right now don't have insurance. Expansion covers working adults without disabilities, who can't enroll in traditional Medicaid.

Some more background. Oklahoma hospitals pay what is called SHOPP. OK Medicaid uses a fee-for-service. States pay part, and feds match. Higher state payments = more federal match. Hospitals help pay for some of their services to increase state share & the federal match.

The committee is talking about a projection in the report. Because more than 100,000 people are expected to have new coverage, they're expected to go to the doctor instead of the ER. It would mean a big hit to hospital ER demand. The committee is concerned it means less SHOPP $

OHCA will phase out Insure Oklahoma, the program that helps employers provide health insurance to lower-wage workers. Corbett says most current members of that will qualify for Medicaid expansion, but the agency will continue coverage for those who aren't.

McCortney: Many of us don't believe we should bring in a for-profit company for managed care. "I think every one of us believes you could do this better." How long would it take to use the agency to implement managed care instead of having a company?
Corbett: "It's a long road."

Corbett: The managed care organizations (private companies) have the infrastructure to get the job done quickly. OK government doesn't have the resources to conduct performance reviews, design financial incentives for providers, etc. We could do it, but it would take investment.