The Oklahoma State Medical Affiliation on Tuesday mentioned it plans to hunt a courtroom injunction in opposition to the state’s lately introduced $2.1 billion Medicaid managed-care program.
The affiliation plans to problem the Oklahoma Well being Care Authority’s determination to permit UnitedHealthcare, Blue Cross and Blue Defend of Oklahoma, Humana Wholesome Horizons and Centene Corp. subsidiary Oklahoma Full Well being to handle Medicaid advantages for the state’s 903,000 enrollees come Oct. 1. The initiative, named SoonerSelect, covers lower-income adults, Momentary Help for Needy Households and the Youngsters’s Well being Insurance coverage Program.
The group mentioned it takes difficulty with personal corporations working the state’s Medicaid program, slightly than the Well being Care Authority. By SoonerSelect, the state can pay personal insurers below a capitated cost mannequin, providing payers a set price per enrollee to coordinate care and permitting payers to elect how they reimburse suppliers. The Oklahoma Well being Care Authority at the moment reimburses suppliers by a fee-for-service mannequin.
Below its lately expanded Medicaid program, the Oklahoma Division of Insurance coverage mentioned an extra 200,000 grownup beneficiaries meet earnings eligibility necessities for protection.
Dr. Woody Jenkins, co-chair of the affiliation’s rural part, mentioned he nervous that non-public insurers would cost inflated charges to cowl their excessive administrative prices, growing affected person care value and disproportionately impacting rural sufferers. He mentioned administrative prices on the Oklahoma Well being Care Authority at the moment run at 5%, whereas administrative bills at managed-care corporations in different states attain at the least 15%.
“All of us need state businesses to run extra effectively, however up to now, we have but to listen to a superb clarification of how eradicating billions of {dollars} from the Well being Care Authority and sending it to largely out-of-state personal corporations can obtain this objective,” Jenkins mentioned in an announcement.
The group additionally takes difficulty with how the company made the choice. The affiliation mentioned that the Oklahoma Well being Authority permitted the managed-care contracts, regardless of an absence of consent from the legislature. Dr. George Monks, president of the Oklahoma State Medical Affiliation, known as for the courtroom to place the bids on maintain till legislators make a closing ruling on the managed-care program.
“Will we need to enable unelected company boards and commissions to probably put the state on the hook for billions of {dollars} in future spending with out dialogue and approval by the legislators who should in the end approve the funding?” Monks mentioned in an announcement.
In an announcement, the Oklahoma Well being Care Authority countered that “Oklahoma legislation supplies full authority for its improvement of the plan to enhance the current supply of the Oklahoma Medicaid Program to the managed-care system.”
The contracts are legitimate for one yr, with 5 optionally available one-year extensions on the state’s discretion. StateImpact Oklahoma estimates that contracts are value a mixed $2.1 billion.