With support from Oklahoma hospitals and state health leaders, the head of Oklahoma's Medicaid agency on Thursday proposed a "rebalancing" of the program that could extend health coverage to 175,000 uninsured residents and trigger an infusion of federal funding.
Oklahoma Health Care Authority CEO Nico Gomez unveiled the four-year plan for Republican legislative leaders and the governor's top health officials, although he cautioned it was just a framework. The idea would involve shifting some 175,000 pregnant women and children who currently receive Medicaid, or Soonercare, onto the private market, where they would be eligible for federal tax subsidies.
"That's the reason why it's not Medicaid expansion, because you're actually taking people off the Medicaid system over the four-year period," Gomez said.
Under the plan, about 175,000 Oklahomans who are currently uninsured and earn below 133 percent of the poverty level, or about $32,000 for a family of four, would then be eligible for a new option through the state's Insure Oklahoma program, which requires individuals to pay premiums based on a sliding scale.
Gomez said the proposal still needs to be fully vetted and would require both federal approval and a state investment of around $100 million.
"Ultimately, it's going to require state funding to match federal dollars, and whenever you're having the conversation about state funding, you'll have to come to the Legislature and the governor," he said.
The plan comes just days after Gomez announced potential cuts of 25 percent in rates paid to Medicaid providers, which health officials say would have a devastating impact on Oklahoma's health care system.
Republican legislative leaders expressed some support for the proposal, which they described as an alternative to Medicaid expansion in Oklahoma.
"We'll be considering that," said House Speaker Jeff Hickman, who attended Thursday's meeting. "Obviously the key factor is how you pay for that, but we're very aware of the situation that's going on with health care, particularly in rural communities."
Among the ideas discussed for helping fund the state's roughly $100 million share of the proposal is a cigarette tax of $1.50 per pack that could generate as much as $182 million. Another idea is to adjust the self-imposed fees paid by hospitals that are used to match federal Medicaid funds.