Make It Stop! Oklahoma’s Managed Care System Hurting Exactly The People It’s Supposed To Help

Families who need health care the most in Oklahoma – foster and adoptive families and those in low income brackets – are having an impossible time getting it since our previous system – SoonerCare – was uprooted to implement a managed care system – SoonerSelect – but how did we get here and what do we do?

HOW DID WE GET HERE?

In 2020, Oklahomans decided (by a very narrow vote on SQ802 and although they had rejected Medicaid expansion as far back as 2016) to provide Medicaid to 200,000 more people in the state than were being served at the time. In bi-partisan opposition – that included Governor Stitt – it was argued that making more Oklahomans eligible for Medicaid would cost Oklahoma tax payers millions of dollars at a time when Oklahoma’s budget was in the red and that patients would receive significantly worse care on a system which would become overburdened by costs and bureaucracy.

Millions and millions of dollars were devoted to convincing Oklahomans to vote ‘Yes’ on the measure by the ideological left and the Hospital Association – the members of which stood to receive federal and state dollars for treating Oklahoma Medicaid patients. Because millions in one-time federal funds were available to help start managed care via President Obama’s Affordable Care Act (dubbed ObamaCare), proponents of the question argued that Oklahoma would be turning away millions in federal funding because of partisan disdain for the HCA and disadvantaging from health care those already financially disadvantaged.

October of 2020, The Oklahoma Health Care Authority (HCA) put together an RFP (Request for Proposals) to institute a ‘managed care’ system in place of the current SoonerCare program.

January 2021, Governor Stitt announced that he would create a new managed care plan for Oklahoma’s Medicaid patients called SoonerSelect. During that month, the HCA awarded 2.2 billion dollars worth of contracts to four companies for administration of SoonerSelect – Blue Cross Blue Shield of Oklahoma, Oklahoma Complete Health (aka Centene), Humana Health Horizons and UnitedHealthcare, though the Oklahoma legislature – the voice of the people – was never consulted on either the RFP, or the selection of the insurance managers.

During early 2021, Oklahoma Health Care officials were told the state would also qualify for approximately 520 million dollars in Federal funds under the American Rescue Plan Act (instituted to ‘help’ Americans with the burgeoning costs of everything during the ‘pandemic’) to help the expansion of the Medicaid program along for two years.

After finding that the Governor and HCA had created an RFP and awarded contracts, the legislature began to push back on the SoonerSelect plan.

March 25th, 2021, several associations representing various Oklahoma medical providers filed a lawsuit against the state arguing that SQ802 didn’t allow the OHCA to award contracts for SoonerSelect to private insurance companies.

June 1st, the Supreme Court upheld the argument of the plaintiffs.

Meanwhile – though the legislature hadn’t gone into the 2021 session believing Oklahoma would institute Medicaid expansion – SB131 was created to put “guard rails” on the creation of a policy should it be brought to the legislature. SB131 was meant to prevent managed care administration of the SoonerSelect program because the legislature preferred – overwhelmingly – for the OHCA to administrate the expansion directly (as it had done with the SoonerCare program) without allowing private insurance organizations to serve as middle men between the HCA and the provider. The bill became law without Governor Stitt’s signature.

Consequently, the 2021 legislative session ended without passage of any specific legislation regarding the SoonerSelect program.

This led the OHCA to try and pass ’emergency rules’ based on SB131 at their board meeting in September, in order for the SoonerSelect managed care process to continue, but the rules were tabled by a 7-1 vote.

Several days after the vote to table, the ONLY physicians appointed to the OHCA by Governor Stitt, Dr. Jean Hausheer and Dr. Laura Shamblin, were removed – also by Governor Stitt – without explanation.

When the legislature resumed in February of 2022, SB1337 – a 44-page version of the Governor’s managed care plan – was introduced via floor substitute, passed after a very lengthy process, and signed by Governor Stitt in May, all to provide the needed legislation for the change to the SoonerCare system that should have been provided from the beginning. This put many legislators who were against managed care from the start in an unenviable position, as they felt they had to vote for SB1337 in order to provide some of the ‘guard rails’ SB131 was to have provided for a managed care system.

SB1337 recognized the three private insurance companies identified in the schematic above, who would act as the middle men between OHCA and healthcare providers. One of these – Centene – has been under investigation and embroiled in lawsuits in multiple states for setting up shell corporations, increasing costs to the state and diverting millions from health care delivery to their own pockets.

WHAT IS GOING ON

Since the implementation of managed care last year, foster families, adoptive families and others qualifying for Medicaid, have been unable to get the services that they had gotten under SoonerCare.

Several Oklahomans have reached out to us about this, so we called Senator David Bullard – a stalwart against the managed care system – to talk about the issue. We also included Salome Vaughn, an adoptive mother to her special needs grandson, who has not been able to receive services for him since the program began.

In the clip below, Senator Bullard describes what managed care is and some of the problems he’s seeing with the program, especially in RURAL AREAS – patients not being seen, doctors leaving the SoonerSelect program because they aren’t being paid, clinics literally going out of business – including an obstetric clinic that helped to deliver babies in the rural area around Hugo, Oklahoma. Everything so many Oklahoma Republican lawmakers said would happen BEFORE Governor Stitt forced this program.

HOW TO MAKE IT STOP

In the clip below, Senator Bullard tells Oklahomans how they can help stop managed care and revert it back to the previous OHCA-administrated system. Oklahomans banded together to remove a large number of moderates from the Senate and House this primary season, we just need to stand together and demand that the legislature STOP the SoonerSelect program and revert to the SoonerCare system in 2025.

As Senator Bullard said, doctors and PA’s need to send emails to, or call, their Representatives and Senators (find them here at the bottom of the page if you don’t know who they are) and ask them to ROLL BACK MANAGED CARE.

And as Salome said, parents with children on SoonerSelect, should do the same thing.

If you would feel better about it, send emails directly to david.bullard@oksenate.gov, but MAKE YOUR VOICES HEARD! WE CAN ROLL BACK MANAGED CARE, BUT ONLY IF YOU STAND UP AND SPEAK OUT NOW before the 2025 session starts.

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