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Oklahoma Medicaid could pay providers more for first time in nine years

[Thinkstock images]
[Thinkstock images]

Oklahoma City — Oklahoma providers who see patients covered by Medicaid could soon get their first rate increase in almost a decade.

The Oklahoma Health Care Authority, which administers the state's Medicaid program, known as SoonerCare, announced Wednesday that it is considering raising rates paid to providers. If the authority's board approves, it would be the first increase since 2009.

The board will consider the increases at its Sept. 13 meeting. If it votes to approve them, providers would start receiving higher rates on Oct. 1.

SoonerCare covers about 796,000 people. Two-thirds are children. Most of the adults are older people living in nursing facilities, people with serious disabilities and low-income parents. Some adults have limited SoonerCare benefits that only cover contraception.

Jo Stainsby, spokeswoman for the authority, said the plan won't require any new state money. That's in compliance with Senate Bill 1605, which Gov. Mary Fallin signed in May, she said. The law required the authority to use savings and drug rebates to increase rates.

Most of the money comes from larger rebates on prescription drugs, though reduced payroll costs during a hiring freeze also helped, Stainsby said. Limiting prenatal cystic fibrosis screening and ending ineligible members' coverage faster also led to more savings than anticipated, she said.

Long-term care facilities would receive a 4 percent increase in their rates, according to the authority. The actual increase would be closer to 3.2 percent, because it would be partially offset by patients paying less toward their care, said Nico Gomez, CEO of the Oklahoma Association of Health Care Providers.

It costs nursing facilities $165.38 per day, on average, to care for patients, Gomez said. The rate increase would raise the state's contribution from $146.06 to $150.74. Nursing facilities still would have to make up the difference with the higher rate they charge private-pay residents, though the increased rate would make that balancing act easier, he said.

“We're grateful” for the increase, he said. “We just have a little further to go.”

Physicians, hospitals and pharmacies would receive a 3 percent increase in their rates. After the increase, doctors who perform a service for a patient covered by Medicaid would be paid, on average, 89 percent of what they are paid to do the same service for a Medicare patient. Nationwide, Medicaid generally pays less than Medicare.

Rick Snyder, vice president of finance and information services at the Oklahoma Hospital Association, said the increase is “welcome and needed.” Hospital rates have fallen by about 14 percent since 2010, he said.

“Some of Oklahoma's rural hospitals have closed, more have needed bankruptcy protection, and quite a few are struggling to make payroll,” he said in an email. “We are encouraged that the legislative leaders have made this step in the right direction.”

Wes Glinnsman, executive director of the Oklahoma State Medical Association, said the increase is a “step in the right direction,” though it doesn't solve all of doctors' funding problems.

“Maintaining adequate provider rates is vital to ensuring Oklahomans in rural and other underserved areas have access to the health care they need,” he said in an email. “After several rate cuts in recent years, we are pleased that the Legislature and the Health Care Authority are making access to care a priority for Oklahoma's most vulnerable citizens.”

Meg Wingerter

Meg Wingerter has covered health at The Oklahoman since July 2017. Previously, she lived in Topeka, Kansas, and worked at Kansas News Service and The Topeka Capital-Journal, where she earned awards for business coverage. She graduated from... Read more ›