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Rep. Sterling The future of Medicaid

Rep. Danny Sterling

One of the most controversial issues of this past legislation session has been the battle over managed care in Oklahoma healthcare. And the battle is long from being over.

The primary battle is between the legislature and the governor. The governor is in favor of having Managed Care Organizations (MCOs) administer the Medicaid Expansion in our state in lieu of continuing with the Oklahoma Health Care Authority (OHCA) to administer through the existing format, known as SoonerCare.

A recent Supreme Court ruling has, at least for the time being, nullified the governor’s plan. The state’s high court decision said OHCA didn’t have the legislative authority to move forward with the managed care contracts with the out-of-state MCO’S.

What we know currently is that Medicaid will expand on July 1 and that the eligible population will be managed like everyone else in Medicaid. There was only a slight hope that privatized managed care could begin in October of this year, but that seems unlikely in that many providers have still not signed up in the MCO’s networks.

One possible scenario would be that of the Governor positioning himself to promulgate emergency rules for proposals (RFPs) and rely on the language of Senate Bill 131. This is the bill that was passed the last week of session to put guard rails in place to address potential mismanagement with MCOs.

Supreme Court Chief Justice Winchester cited in his dissenting opinion as the remedy for this entire issue is the governor promulgating the emergency rules. To this point, Senator Greg McCortney has addressed this avenue by saying that this was not the intent of the legislation.

It is speculated that there will be at least one more court case on this issue. Another viable option would be for the governor to come back to the Legislature for further discussions on how to remedy this situation that will be beneficial for all parties involved.

All in all, this situation is still uncertain and nobody really knows what is going to happen at this point. We will just have to see how it all plays out.