The state’s Medicaid director will propose an almost 8 percent rate cut for medical professionals who provide health care to some of Oklahoma’s poorest residents.
Nico Gomez, the CEO of the Oklahoma Health Care Authority, said he will propose a 7.75 percent provider rate cut to ensure that his agency will have a balanced budget in the coming fiscal year, which begins July 1.
“It’s really the best case scenario after a very tough budget situation,” Gomez said.
The Oklahoma Health Care Authority administers the state’s Medicaid program, known as SoonerCare, which provides access to health care for lower-income Oklahomans, a majority of whom are children.
For the upcoming fiscal year, the agency will receive the same amount of money from the Legislature as it did last year, despite its leadership’s request for more dollars.
Gomez said his agency requested more money after it learned it would receive a drop in federal money, among other funding issues.
The health care authority expects to see a $50 million reduction in federal money. That’s because the rate that the federal government pays the authority to deliver Medicaid services was recalculated. The amount of money that the federal government provides each state for Medicaid, including Oklahoma, is based on a formula that incorporates a state’s per capita income.
Because Oklahoma’s economy has improved, the thought is that fewer Oklahomans would need Medicaid. However, that hasn’t been the case, leaders said.
Also, the authority will see a reduction in tobacco tax revenue, which implies fewer Oklahomans are smoking, which is good news, Gomez said.
To make up for these cuts in funding, Gomez will propose a list of approaches that the agency can take to ensure a balanced budget, including cutting provider rates.
Gomez said since 2000, the agency has cut provider rates only one other time, in 2010 when there was a state revenue failure, which occurs when the state does not have enough money to pay agencies their monthly allotment of funding.
If the board approves the provider rate cut, medical providers who bill Medicaid will be reimbursed 89.25 percent of what Medicare pays, Gomez said. Medicare is the federal program that providers access to health insurance for residents 65 and older, among some other groups.
Meanwhile, the Oklahoma Department of Mental Health and Substance Abuse Services, which manages Medicaid services for outpatient behavioral health, has not determined whether the agency will have to cut provider rates.
Providers who deliver outpatient behavioral health are reimbursed 70 percent to 75 percent of Medicare.
“All options are on the table now as we finalize our budget for the coming year,” agency spokesman Jeff Dismukes said.