'This is not good': OHCA responds to concerns over SoonerSelect

OKLAHOMA CITY, Okla. (KOKH) — On Thursday, an Oklahoma Health Care Authority representative sat down with FOX 25 for a wide-ranging interview on the rollout of SoonerSelect, the state's managed care model for Medicaid.

The shift to SoonerSelect took effect on Apr. 1. State lawmakers passed Senate Bill 1337 in 2022, which directed the OHCA to make the change.

Two years later, however, some are expressing concern over the program.

During a Jun. 5 press conference, providers and concerned Oklahomans argued Medicaid was in "crisis" due to the change.

Under the new system, private insurance companies are administering Medicaid members' plans.

The program impacts many. According to a Jun. 2023 Kaiser Family Foundation report, 20 percent of Oklahoma is covered by Medicaid or the Children's Health Insurance Program.

Providers have raised the alarm that insurance carriers were failing to pay for services, leading some to worry about the future of clinics statewide.

OHCA Chief of Staff Christina Foss noted, "We always take our provider concerns extremely seriously... We want our members to be served. And so any provider concern like that, again, I, we encourage them to reach out to the health care authority."

According to the OHCA, $250 million in claims have been paid out since Apr. 1, and the new program is set to pump an additional half a billion dollars into state hospitals.

The authority is also highlighting new member services possible under managed care, like help with food, items for newborns, and proactive interventions on behalf of patients.

On the other hand, State Sen. David Bullard (R-Durant) argued the rollout has been a disaster based on the concerns he's hearing about from providers across the state.

When asked how the OHCA would rate the rollout so far, Foss responded, "We're really excited about the rollout so far, you know, like I mentioned, we're just a little over two months in and we're already seeing a lot happening in our members' lives."

Sen. Bullard asserted, "I wish I could live in the same land of puppies and sunshine that the health care authority's living in right now. Unfortunately, I'm hearing directly from doctors who are saying this is not good."

Amid ongoing concerns over issues with payments to providers, the OHCA said it's offering financial assistance to tide providers over as issues get resolved.

Sen. Bullard is countered, asserting that current efforts are insufficient and the damage could be irreversible if nothing changes soon.

According to the OHCA, the agency is committed to helping providers and holding insurance companies accountable.

Sen. Bullard said providers have described long wait times trying to get ahold of OHCA representatives to discuss concerns.

Foss noted, "We talk regularly with the plans and providers to facilitate resolutions. OHCA has also held numerous in-person office hours in addition to regular virtual office hours so that every provider is equipped to be successful with SoonerSelect. The plans continue to hold virtual office hours several times a week – those opportunities can be found on our website."

The lawmaker called the SoonerSelect rollout "premature."

The OHCA chief of staff stated, "The Oklahoma Health Care Authority received multiple federal approvals before the rollout of this program. CMS reviews the state’s readiness plans as well as the months-long process of receiving the appropriate federal authorities to operate."

Sen. Bullard further called for a pause on the current program to allow officials to address concerns.

In response, Foss explained, " State law and Oklahoma’s federal authorities require certain populations to transition to a managed care delivery system. The state is operating under federal authority to manage the care of the mandatory populations in the SoonerSelect program through a 1915b waiver. Systems would require at least 60-90 days to revert back to payments through a fee-for-service delivery system. The enhanced supplemental payments are only possible in a managed care environment as well, so providers would not receive the $700 million in additional payments."