OKLAHOMA CITY — The Oklahoma Health Care Authority board voted unanimously Thursday to increase copayments for state Medicaid participants to the federal level, along with a series of other rules changes meant to compensate for a budget shortfall.
The change will increase copays for most services to $4 and will be effective Tuesday, or immediately upon the governor’s signature.
The Health Care Authority administers the state’s Medicaid program, called SoonerCare.
David Blatt, executive director of the Oklahoma Policy Institute, spoke against raising copays during the public comment period.
Doing so would harm the physical health and financial well-being of SoonerCare participants, he said.
“Some recipients will simply stop taking their medications,” he said.
People are also reading…
Blatt said the increases would not lead to savings for the Health Care Authority, although the authority claims a total savings of about $8.3 million and a state savings of about $3.1 million.
Higher copays have been shown to lead to increased emergency room visits and an increase in catastrophic medical events for people with chronic health conditions who stop accessing health care. All of this means higher costs to OHCA, according to a letter Blatt presented to the board.
Another rule approved Thursday will limit patient visits to federally qualified health centers to four visits per SoonerCare participant per month.
Another rule change will reduce or deny payments for preventable hospital readmissions that occur within 30 days of an acute care admission. Previously, the rule denied or reduced payments for readmissions within 15 days.
A rule initiated by the Oklahoma Department of Mental Health and Substance Abuse Services will add eligibility requirements to receiving psychosocial rehabilitation services.
Nico Gomez, OHCA executive director, said the board made some difficult decisions Thursday.
“Unfortunately, we weren’t able to get the appropriations we needed to avoid these actions today,” he said.
The board postponed action on proposed cuts in reimbursement rates to doctors and other medical providers. That will be addressed at a special meeting Tuesday.
Board chairman Ed McFall said the solution to OHCA’s budget problem is at the state Capitol.
“Providers are upset. Members are upset,” he said. “I encourage you to communicate with your legislator.”
Board member and former state Sen. George Miller said he didn’t like the new rules approved Thursday, even though he voted for all of them.
He said he wished he still had a vote in the state Legislature.
“I made some of the toughest votes today that I’ve ever made in my life,” he said. “I’m against every one of these rules but I can’t help it.”
SoonerCare copay charges
Service | Copay |
Ambulatory surgery centers | $4 per visit |
Behavioral health inpatient | $75 per visit |
Chemotherapy and radiation | $4 per visit |
Clinical services including dialysis | $4 per visit |
Diabetic supplies | $4 per claim |
Diagnostic x-ray services | $4 per visit |
Durable medical equipment/supplies | $4 per claim |
Emergency services | None |
Home health services | $4 per visit |
Immunizations | $4 per date of service |
Inpatient hospital services (acute care) | $75 per visit |
Laboratory | $4 per visit |
Outpatient hospital services | $4 per visit |
Physical/occupational/speech therapy | $4 per visit |
Preventive services | $4 per visit |
Podiatry services | $4 per visit |
Prescription drugs and insulin | $4 each prescription |
Prenatal, deliver, postpartum services | None |
Rural health clinic services | $4 per visit |
Specialty clinic visits | $4 per visit |
Tuberculosis services | $4 per visit |
Source: Oklahoma Health Care Authority