Oklahoma

The Oklahoma Health Care Authority (OHCA) is developing a request for proposals (RFP) regarding the implementation of SoonerHealth+, a fully capitated statewide care coordination model aimed at the state’s Aged, Blind and Disabled (ABD) populations. Enrollment into the program is anticipated to happen over three years within the following parameters:

• Year 1: SoonerCare Choice Medicaid only members; “full benefit” dual eligible members; Advantage and Medically Fragile waiver members; I/DD state plan only members.
• Year 2: I/DD waiver beneficiaries.
• Year 3: residents of long term care facilities.

On November 30, 2016, the Oklahoma Health Care Authority (OHCA) issued a request for proposals (RFP) for MCOs to manage care for the SoonerHealth+ Program, which was initiated following the passage of HB 1566 through the state legislature in 2015 and required OHCA to issue an RFP for care coordination for the state’s Aged, Blind and Disabled (ABD) population. The state estimates the current ABD population is, as of June 2016, 154,795 beneficiaries, including adults and children from a number of different HCBS waivers.

Oklahoma will be phasing in different populations into managed care under varying timelines. All members of the SoonerCare (Oklahoma’s Medicaid program) Aged, Blind and Disabled population will be enrolled into SoonerHealth+ on a mandatory basis, as well as:

• ABD members eligible for Medicaid but not eligible for Medicare;
• Dually eligible ABD members; and
• Children under age 19 receiving services under the Tax Equity and Financial Responsibility Act.

In year one, all ABD members that meet nursing facility (NF) LOC and receiving HCBS will also be enrolled into SoonerHealth+. Native American ABD members will have the option to enroll into SoonerHealth+ if they choose, and can disenroll during any open enrollment period. Additional population considerations are as follows:

• SoonerCare members 55 and older deemed eligible for SoonerHealth+ are given the option to enroll in a Program of All-Inclusive Care for the Elderly (PACE) program, if available in their community;
• Individuals with an intellectual disability (ID) eligible for Intermediate Care Facility for Individuals with an Intellectual Disability (ICF-ID) LOC and receiving HCBS services are carved out for year one, but will be mandatorily enrolled in year two; and
• ABD members residing in a NF or ICF-ID are carved out for the first two years of the program, but will be enrolled thereafter.

SoonerHealth+ enrollment will be split between two regions, a West Region and an East Region, which contain 46 and 31 counties, respectively. MCOs are able to bid for one or both of the regions under the RFP. OHCA expects to award three contracts per region, although the state may also award as few as two and as many as four if the state so chooses.

Interestingly, OHCA notes that the state reserves the right to implement a financial alignment demonstration or Medicare shared savings initiative for dual eligible beneficiaries enrolled in SoonerHealth+, in coordination with CMS and MCOs. 

Proposals are due to the state on February 28, 2017, by 2:00pm. OHCA intends to commence enrollment of the year one populations starting in January 2018. (Source: RFP 11/30/2016)  

On May 18, 2017, NON DOC reported that political leaders in Oklahoma are growing increasingly cautious as the state moves toward the implementation of an MLTSS program. In a letter dated May 10, 2017, Governor Fallin instructed the Oklahoma Health Care Authority (OHCA) to delay implementation of the program until July 1, 2018. Also, the Oklahoma House of Representatives passed a resolution—without the force of law—asking OHCA to hold off awarding or signing any contracts with MCOs until more information becomes available from the Federal government regarding supplemental payments to hospitals. Stakeholders are concerned that the state’s Supplemental Hospital Offset Program (SHOP) may be in jeopardy under a new rule released in January 2017 that impacts states implementing new managed care programs. (Source: Non Doc 5/18/2017)

On June 14, 2017, the Oklahoma Health Care Authority (OHCA) announced the cancellation of the RFP to procure contracts for SoonerHealth+, which would have implemented a fully capitated MLTSS program to coordinate care for Oklahoma’s aged, blind, and disabled (ABD) population. OHCA stated the reason for the cancellation was due to a lack of funds being appropriated from the legislature to support the new care model. (Source: OHCA 6/14/2017) 

On January 12, 2018, Oklahoma Senator, and chair of the Senate Appropriations Committee, Kim David published an article in NewsOK on the need to modernize the state’s Medicaid delivery system through the implementation of risk-based managed care. The state Medicaid agency, the Oklahoma Health Care Authority (OHCA), cancelled a request for proposals (RFP) to move forward with a capitated care coordination program for the aged, blind, and disabled (ABD) population in June 2017, citing a lack of funding the agency had requested to implement the program. The senator notes that the state could save as much as $400 million over a decade if it implements Medicaid managed care, and also increase budget predictability and improve quality of care. Finally, Senator David notes that a new proposal to implement Medicaid managed care will be introduced in the 2018 regular session of the legislature. (Source: NewsOK 1/12/2018; Senator Statement 6/15/2017)