Stitt health plan has administration's support
Gov. Kevin Stitt revealed Thursday his plan to expand Medicaid in Oklahoma.
Alongside federal officials in Washington, D. C., Stitt outlined his vision to expand Oklahoma's Medicaid program to cover low- income working adults and fund the expansion with a Medicaid block grant that has the Trump administration's stamp of approval.
Federal health care officials announced Thursday that states will be allowed to receive the Medicaid block grants to cover low-income, working adults — the Medicaid expansion population. Stitt was on hand to offer his enthusiastic support.
Stitt, who was the only governor in attendance at the announcement by the Trump administration and the Centers for Medicare and Medicaid Services, called the directive a “game changer.”
CMS' Healthy Adult Opportunity program will allow Oklahoma to implement
SoonerCare 2.0 and capture Medicaid dollars in a way that is more stable and accountable, he said. Oklahoma's existing Medicaid program is called SoonerCare.
In the coming weeks, the state will submit a Medicaid state plan amendment to CMS along with applications for Healthy Adult Opportunity waivers to charge some Medicaid beneficiaries modest premiums and impose work requirements that will require them to hold a job, attend school or be involved in the community. That will ensure Oklahomans have “skin in the game,” Stitt said.
“CMS and the Trump administration have been listening to the needs of states like Oklahoma,” Stitt said in Washington, D.C. “From my constituents, I am here to say, `Thank you.' Thank you for listening, thank you for innovating, and thank you for putting health care back to where it belongs — with the states.”
Congressional Democrats, who warned the administration not to issue a guidance supporting block grants, have indicated they will fight this directive. House Speaker Nancy Pelosi called the block grant proposal illegal.
Block grants will allow states more flexibility in how they administer their Medicaid programs, CMS Administrator Seema Verma said. But states will have to adhere to greater accountability measures to show they are improving health outcomes for those receiving coverage under a block grant system.
“With this flexibility will come strict accountability for results,” she said.
Stitt said he's pleased that under the proposal, states will be incentivized to find cost savings in how Medicaid is administered.
SoonerCare 2.0 will bring in about $1 billion in additional Medicaid funding, Stitt said. He anticipates Oklahoma will have to chip in about $150 million.
To cover that, Stitt plans to increase hospital assessment fees and use anticipated cost savings in the Department of Corrections and the Department of Mental Health and Substance Abuse Services, where the state currently covers many of the health care costs the federal government would cover under Medicaid expansion.
He also wants to reform Oklahoma's Tobacco Settlement Endowment Trust to allow future funds to be directed toward improving rural health care offerings under SoonerCare 2.0. It is unclear if the changes he seeks would require amending Oklahoma's constitution because TSET was approved by voters through a constitutional amendment.
Stitt also said he anticipates block grants will allow Oklahoma increased flexibility to expand treatment for opioid addiction and improve rural health care.
As part of the change, Stitt hinted he plans to consolidate some of the state's health care agencies to improve service for Oklahoma residents. When pressed for details by local repofrters, Stitt advised he will say more Monday in his State of the State speech.
“We're going to be looking at more of an outcome-based delivery model for this population and consolidation of some of the health care delivery agencies,” he said. The governor also envisions reforming Oklahoma's managed care program, SoonerCare Choice.
The block grants will not cover Oklahoma's current Medicaid population. Under the block grant model, states would be required to cover all ablebodied, working adults whose annual income does not exceed 138% of the federal poverty level.
Oklahoma's current Medicaid population will continue to be funded by the traditional Medicaid funding formula, in which the federal government covers a portion of state Medicaid costs based on the number of low-income residents who need that coverage.
The Trump administration guidance could set off a legal firestorm if Medicaid advocates file lawsuits over the directive. Verma shrugged off such concerns, saying some people were criticizing the proposal before they saw the details. She expressed confidence the administration would come out on top in any litigation.
“We feel we are on very, very strong legal standing,” Verma said. Stitt also dismissed questions about possible litigation.
Critics of block grant proposals say the funding mechanism is not as flexible as traditional Medicaid funding and could reduce the amount of federal funding Oklahoma receives, leading to fewer people receiving Medicaid coverage.
States seeking a block grant can choose to receive either a lump sum of funding or a set amount of funding for each Medicaid enrollee. Medicaid block grants are optional for states.
Stitt opposes State Question 802, which will be on the ballot later this year, asking voters to expand Medicaid in Oklahoma. Stitt, whose duty it is to set the election date, has not yet said when the question will come up for a vote.