View Full Version : Medicaid Expansion Coming to Oklahoma



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king183
03-17-2020, 10:25 AM
I decided to start this based on a comment in another thread that indicated some people aren't aware the state is in the process (https://oklahoman.com/article/5656661/oklahoma-will-submit-medicaid-expansion-request-friday-gov-kevin-stitt-says) of officially expanding Medicaid (not Medicare, which is the federal health program primarily for people over the age of 65). With the COVID 19 response filling the news, a lot of people are likely unaware.


The Oklahoma Health Care Authority on Friday will submit to the federal government a state plan amendment seeking to expand Medicaid in Oklahoma as soon as this summer.

"The Health Care Authority has the authority to send in the paperwork to expand, and we’re going to get that out on Friday," Gov. Kevin Stitt told The Oklahoman on Thursday.

The state plan amendment will get the ball rolling for Oklahoma to seek federal approval to expand Medicaid.

The expansion will likely become effective in June or July. As a condition of expanding, the state is going to have to pay 10% of the total costs for the newly eligible population, which is expected to be $150 million a year. The legislature has not yet decided how they will fund that obligation, but several options are being considered, including increasing the assessment on hospital revenues, called the Supplemental Hospital Offset Payment Program. This is an assessment hospitals pay to the state, which is in turn used to get matching funding from the federal government. It is intended to keep provider reimbursements higher than they would be absent the assessment.

After expansion is in place, the Stitt Administration intends to make changes to the program. The administration is working with Health Management Associates (https://www.healthmanagement.com/), a consulting firm out of Michigan with ties to the Trump Administration, to submit a "Healthy Adults Opportunity" waiver application that will enact work/community engagement requirements and require those on the program to pay modest premiums.

Separate from all of this, there will soon be a state question--SQ 802-- before the people to decide whether to make the expansion part of the Oklahoma Constitution and prohibit the legislature or the Health Care Authority from adding any restrictions to the program. Governor Stitt has not yet decided when to place the question on the ballot.

HangryHippo
03-17-2020, 10:35 AM
Regardless of personal stance, Stitt needed to get off his ass and set an election. The people want it voted on and it needs to happen.

That being said, coronavirus has certainly thrown a wrench into everything.

Laramie
03-17-2020, 12:04 PM
Regardless of personal stance, Stitt needed to get off his ass and set an election. The people want it voted on and it needs to happen.

That being said, coronavirus has certainly thrown a wrench into everything.

Good point Nick, at least allow the people to vote. The expansion will allow for more coverage of Oklahomans throughout the state and save many rural hospitals.


As of Aug. 1, Oklahoma was one of 14 that had not accepted expansion, according to a count from the Kaiser Family Foundation.

Key Facts to Know About Medicaid Expansion Proposal: https://oklahomawatch.org/2019/08/19/facts-to-know-about-medicaid-expansion-proposal/

king183
03-17-2020, 12:34 PM
Just to be clear: Medicaid expansion is happening regardless of the vote on SQ 802. The question is whether Medicaid expansion is put in the Oklahoma Constitution or not.

Come July 1, assuming the feds approve it, Oklahoma will have Medicaid expansion.

emtefury
03-17-2020, 06:52 PM
Great. More of my tax dollars going towards other people's free stuff.

Plutonic Panda
04-18-2020, 03:25 PM
The vote date has been set to June 30th for the ballot version of the expansion:

https://nondoc.com/2020/04/17/sq-802-stitt-sets-election-date-on-medicaid-expansion/

TheTravellers
04-18-2020, 04:38 PM
The vote date has been set to June 30th for the ballot version of the expansion:

https://nondoc.com/2020/04/17/sq-802-stitt-sets-election-date-on-medicaid-expansion/

About time. Although his SoonerCare 2.0 thing could mess with it, I need to read more about how both of those will interact if the SQ passes and SoonerCare 2.0 goes into effect. I'll be voting in person for this one, most likely, because absentee voting in OK requires a notarization of the ballot, so if you do it, you *still* have to interact with somebody in person. :(

Plutonic Panda
04-18-2020, 04:41 PM
I’m interested in how the sooner care 2.0 will interact with this as well.

king183
04-18-2020, 05:08 PM
Interact how? I can probably answer that for you. The SQ would effectively prevent many of the provisions of the SoonerCare 2.0, such as the community engagement requirements and the nominal copayments/premiums.

I personally think the SQ is ill-advised because it will either prevent or make extremely difficult the enactment of future innovative solutions, such as a variety of value-based payment arrangements.

The expansion will happen without the SQ passing. And, candidly, the courts will strike down the governor’s proposed community engagement requirements, so I don’t see any benefit to hamstringing future efforts to innovate on the program through a constitutional amendment.

Bits_Of_Real_Panther
04-18-2020, 06:54 PM
I'm in favor of reducing the number of people in this state who have no health insurance.

I'll have to figure out how to get my absentee ballot notarized.

king183
04-19-2020, 12:34 AM
I'm in favor of reducing the number of people in this state who have no health insurance.

I'll have to figure out how to get my absentee ballot notarized.

I know I’ve written this before on here, but it is worth repeating because there are so many moving parts to this and it’s difficult for people to keep up: the expansion of Medicaid to uninsured, childless adults is going to happen on July 1, whether the SQ passes or fails. You don’t need to vote to expand Medicaid. The vote is, for all intents and purposes, whether to put Medicaid expansion in the constitution and to restrict the ability of the Oklahoma Health Care Authority from make certain changes to the program over time.

Edmond Hausfrau
04-19-2020, 08:52 AM
I'm in favor of reducing the number of people in this state who have no health insurance.

I'll have to figure out how to get my absentee ballot notarized.

Next we should vote on removing the notary requirement. Now is the right time to drop it and move to true "vote by mail." It would also be a boon to the rural Oklahoma communities where people don't live "in town".

Edmond Hausfrau
04-19-2020, 08:54 AM
Great. More of my tax dollars going towards other people's free stuff.

Isn't that how taxes work?

TheTravellers
04-19-2020, 01:05 PM
Next we should vote on removing the notary requirement. Now is the right time to drop it and move to true "vote by mail." It would also be a boon to the rural Oklahoma communities where people don't live "in town".

Absolutely, but I don't think we can get that done this year, wouldn't it have to be the legislature that does it? And they're pretty much done for this session (my Rep told me that all they're going to do is get the budget done and they're outta there). Or can the state Election Board do it unilaterally?

Bunty
04-20-2020, 10:11 AM
Great. More of my tax dollars going towards other people's free stuff.

Then bet on SQ 802 being voted down if opponents talk like the only way to pay for it is by raising the state sales tax by .5 or whatever. Or by some other form of tax hike, such as on gas. The former, I think, would be less acceptable. The Medicaid plan that Gov. Stitt has come up with will be regarded as better than nothing, especially if no tax hike is required to pay for it.

David
04-20-2020, 10:18 AM
Given the enthusiasm for signatures on the petition, I'm not sure I'd count on it being voted down. The current virus situation may have an impact on the June 30th election date, but who knows which direction that impact would lean.

Edmond Hausfrau
04-20-2020, 04:52 PM
Is there any reason we can't take the federal Medicaid expansion, drop Stitt's 2.0 "community engagement" work requirements, and not add something onerous to the Oklahoma Administrative Code that 30 years from now will read as ridiculously as the old state liquor laws once read?

TheTravellers
04-20-2020, 05:54 PM
Is there any reason we can't take the federal Medicaid expansion, drop Stitt's 2.0 "community engagement" work requirements, and not add something onerous to the Oklahoma Administrative Code that 30 years from now will read as ridiculously as the old state liquor laws once read?

Would be nice, but probably won't happen because...Stitt.

jerrywall
04-21-2020, 10:06 AM
Interact how? I can probably answer that for you. The SQ would effectively prevent many of the provisions of the SoonerCare 2.0, such as the community engagement requirements and the nominal copayments/premiums.

I personally think the SQ is ill-advised because it will either prevent or make extremely difficult the enactment of future innovative solutions, such as a variety of value-based payment arrangements.

The expansion will happen without the SQ passing. And, candidly, the courts will strike down the governor’s proposed community engagement requirements, so I don’t see any benefit to hamstringing future efforts to innovate on the program through a constitutional amendment.

This and the fact that the SQ doesn't address (that I could find) the funding issue at all, so we might as well be voting on free unicorns, is why I'll be voting no.

HangryHippo
04-21-2020, 10:12 AM
Would a yes vote actually prohibit the brain trust at 23rd and Lincoln from doing anything to modify what that yes vote would put in place? Or would it just make it more difficult to change?

Jersey Boss
04-21-2020, 11:29 AM
Then bet on SQ 802 being voted down if opponents talk like the only way to pay for it is by raising the state sales tax by .5 or whatever. Or by some other form of tax hike, such as on gas. The former, I think, would be less acceptable. The Medicaid plan that Gov. Stitt has come up with will be regarded as better than nothing, especially if no tax hike is required to pay for it.

I don't see a tax hike doable with the 75% requirement. More likely will be a reduction somewhere. Closing some CC campuses or some other such method of cuts. Maybe sell off some of the real estate the state holds?

Jersey Boss
04-21-2020, 11:33 AM
This SQ is a result of the legislature giving a chorus of no in the past, over the objections of the Governor at the time. The legislature has had more than enough time to have crafted a bill that would have not made the SQ such a popular option.

Edmond Hausfrau
04-21-2020, 02:33 PM
Maybe it's time to consider redrawing some legislative districts to get more diversity of thought in the Capitol.

Bunty
04-23-2020, 10:06 PM
Maybe it's time to consider redrawing some legislative districts to get more diversity of thought in the Capitol.

Why? Are rural districts acting like they're not as much concerned as they should be about the future of their medical care? If so, I'm not sure urban districts would be very sympathetic about the needs of the rural districts.

Edmond Hausfrau
04-24-2020, 01:44 PM
Absolutely, but I don't think we can get that done this year, wouldn't it have to be the legislature that does it? And they're pretty much done for this session (my Rep told me that all they're going to do is get the budget done and they're outta there). Or can the state Election Board do it unilaterally?

Or we can just see how this lawsuit plays out. I had no idea that only 3 states in the union require a notary, and we are one of the unfortunate 3.
Since the suit names the Secretary of Election Board, I am supposing that is who has the ability to change the rule?
https://www.tulsaworld.com/news/state-and-regional/league-of-women-voters-sues-election-board-over-absentee-ballot-requirements/article_6a54c66a-7078-5197-af99-b2cfab6f3366.html?utm_medium=social&utm_source=facebook&utm_campaign=user-share&fbclid=IwAR0HWvxbiHeTp7KgnEMr6u50z1dm9h8hjG595zBkt ZNnqHFlMEzO2eMRAWU

TheTravellers
04-24-2020, 03:54 PM
Or we can just see how this lawsuit plays out. I had no idea that only 3 states in the union require a notary, and we are one of the unfortunate 3.
Since the suit names the Secretary of Election Board, I am supposing that is who has the ability to change the rule?
https://www.tulsaworld.com/news/state-and-regional/league-of-women-voters-sues-election-board-over-absentee-ballot-requirements/article_6a54c66a-7078-5197-af99-b2cfab6f3366.html?utm_medium=social&utm_source=facebook&utm_campaign=user-share&fbclid=IwAR0HWvxbiHeTp7KgnEMr6u50z1dm9h8hjG595zBkt ZNnqHFlMEzO2eMRAWU

Thanks for that info, hadn't heard about it yet, hope it gets settled in time for the June 30 election. Also interesting to note the signed statement option, never read about that anywhere on the Election Board's website or anyplace else I was looking for OK absentee ballot info. And it's not the Secretary of the Election Board who could make the change, because of this in the article:

"Attorneys for the group earlier this week asked Ziriax to make the change.

He declined, saying removing the requirement for a notary for absentee ballots was beyond the scope of his duty."

Edmond Hausfrau
04-24-2020, 09:33 PM
Why? Are rural districts acting like they're not as much concerned as they should be about the future of their medical care? If so, I'm not sure urban districts would be very sympathetic about the needs of the rural districts.

I was mainly responding to Jersey Boy statement that the legislature couldn't seem to get the will of the people done, hence the popular SQ vote. I don't know that it was a urban/rural split as I don't really follow politics. I just figured redrawing district lines might result in different voting outcomes.

king183
05-22-2020, 05:31 PM
Well, I certainly didn’t expect Stitt to kill his own Medicaid expansion plan with a veto of the bill to fund it—all because he didn’t realize when the economy goes south, more people become eligible for the program. So, if expansion is going to happen, it will now happen with the state question. It honestly blows my mind how Stitt keeps making rookie mistakes, but he is depending on outside consultants who don’t know Oklahoma, so maybe it shouldn’t be surprising.

Bunty
05-23-2020, 12:58 PM
I seem to recall the legislature paying a firm to study whether Oklahoma should accept Medicaid. It came back to go for it.

Once I again, I don't understand why so many conservative state office holders don't take the issue of health care more seriously, unless they can't see the seriousness of it from they and their family members always being blessed with good health. Stitt's tweet with his kids in a restaurant, later deleted, spoke volumes. And if they're well off, like Stitt, the price of health insurance may not be much of an issue, either.

Edmond Hausfrau
05-24-2020, 10:26 AM
I'm just baffled. 13.7% unemployment, many have not received their unemployment $ and the governor thinks this is the wrong time to expand healthcare access? Isn't the right time to expand when people lose their employee health benefits, if they even had any?

TheTravellers
05-24-2020, 01:15 PM
I'm just baffled. 13.7% unemployment, many have not received their unemployment $ and the governor thinks this is the wrong time to expand healthcare access? Isn't the right time to expand when people lose their employee health benefits, if they even had any?

You're thinking logically, like someone who actually cares about the social safety net - that's the disconnect.

Plutonic Panda
06-30-2020, 10:02 PM
It passed!! :)

HangryHippo
06-30-2020, 10:06 PM
It passed!! :)
Barely, but I'll take it.

TheTravellers
06-30-2020, 10:38 PM
Interesting that absentee ballots were heavily in favor (including ours), while in-person voting was completely opposite.

Bunty
06-30-2020, 11:37 PM
Interesting that absentee ballots were heavily in favor (including ours), while in-person voting was completely opposite.

Only 7 counties voted for it, Oklahoma, Cleveland, Tulsa, Payne, Comanche, Cherokee and Pontotoc. Once again, the highly conservative rural vote couldn't overcome the urban vote in a state question.

It will be important to vote yes on SQ814 for it to help provide funding for 802:
https://www.tulsaworld.com/opinion/editorials/tulsa-world-editorial-sq-814-asks-voters-to-reconsider-how-health-care-is-funded-in/article_1b1bbfc2-e617-52b3-880f-068b3368f2f9.html

Swake
07-01-2020, 12:03 AM
It's insane because the largest benefit will be for rural health and hospitals. Who voted against it.

Scott5114
07-01-2020, 02:43 AM
The Chickasaw Nation endorsed the Yes vote on SQ 802, so my guess is that's what drove the Yes vote in mostly-rural Pontotoc County.

TheTravellers
07-01-2020, 08:27 AM
Only 7 counties voted for it, Oklahoma, Cleveland, Tulsa, Payne, Comanche, Cherokee and Pontotoc. Once again, the highly conservative rural vote couldn't overcome the urban vote in a state question.

It will be important to vote yes on SQ814 for it to help provide funding for 802:
https://www.tulsaworld.com/opinion/editorials/tulsa-world-editorial-sq-814-asks-voters-to-reconsider-how-health-care-is-funded-in/article_1b1bbfc2-e617-52b3-880f-068b3368f2f9.html

Thanks for the info, I didn't delve into the cause too much, but yeah, absentee ballots were most likely done by non-rural smart voters, then the rural voters show up in person to shoot themselves in the foot.

jdizzle
07-01-2020, 08:32 AM
My only concern is how the state will fund their portion. Will it be a tax increase, or steal from other departments?

Or will they add a fee to hospital visits?

TheTravellers
07-01-2020, 09:26 AM
My only concern is how the state will fund their portion. Will it be a tax increase, or steal from other departments?

Or will they add a fee to hospital visits?

Bunty's post has an interesting and feasible proposal.

https://www.okctalk.com/showthread.php?t=45646&p=1127099#post1127099

Swake
07-01-2020, 09:35 AM
Over time from an economic perspective this will pay for itself. We will spend one tax dollar for ten dollars of spending in the economy, spending that will then roll over in the economy 2-3 times which will in turn generate a lot more than one dollar in new taxes.

The arguments against expansion in Oklahoma have always been bad. Not just from a moral perspective, but from an economic one as well.

Bunty
07-01-2020, 11:20 AM
Thanks for the info, I didn't delve into the cause too much, but yeah, absentee ballots were most likely done by non-rural smart voters, then the rural voters show up in person to shoot themselves in the foot.

The governor is possibly gonna be a poor loser:

Massive Voting Irregularities on - Call For FBI Criminal Investigation:

SQ802 is under a cloud of criminal suspicion during the overnight hours following the close of primary night voting.

The mailed in ballots far exceeded previous norms, but more important to the Attorney General's office, should be the vast contrast between the 80% support for Medicaid expansion claimed in these faceless ballots, and the election day rejection of taxpayer-funded health benefits by a 10% margin of deficit.

The Governor is expected to call on AG Mike Hunter to seek a court injunction for a stay of the certification, until an investigation can be completed.
https://www.soonerpolitics.org/editorial/massive-voting-irregularities-call-for-fbi-criminal-investigation

HangryHippo
07-01-2020, 11:28 AM
That reads more like a salty blog page as opposed to anything legitimate. Right-wingers are trying to sow election discord in preparation for November.

Bunty
07-01-2020, 11:31 AM
It's insane because the largest benefit will be for rural health and hospitals. Who voted against it.

Tax hikes. It seems the rural Oklahoma political culture is opposed to all tax hikes at the state level and to most change in general. They are a lot more accustomed to doing with less in their daily life than urban folks. Some rural counties don't even have so much as a Wal-Mart or a hospital.

TheTravellers
07-01-2020, 11:50 AM
That reads more like a salty blog page as opposed to anything legitimate. Right-wingers are trying to sow election discord in preparation for November.

Yep, absolutely, in probably every election. This can easily be explained as it has been in the past few posts - smart non-rural voters that see the benefit of it and aren't opposed to taxes and are in favor of social safety nets voted by absentee in huge numbers because of the pandemic, while rural voters don't see any problems with voting in-person (less crowded polling places, etc.) and don't like taxes or social safety nets, so voted against it.

David
07-01-2020, 12:06 PM
The governor is gonna be a poor loser:

Massive Voting Irregularities on - Call For FBI Criminal Investigation:

SQ802 is under a cloud of criminal suspicion during the overnight hours following the close of primary night voting.

The mailed in ballots far exceeded previous norms, but more important to the Attorney General's office, should be the vast contrast between the 80% support for Medicaid expansion claimed in these faceless ballots, and the election day rejection of taxpayer-funded health benefits by a 10% margin of deficit.

The Governor is expected to call on AG Mike Hunter to seek a court injunction for a stay of the certification, until an investigation can be completed.
https://www.soonerpolitics.org/editorial/massive-voting-irregularities-call-for-fbi-criminal-investigation

That looks like some random dude's blog, is there any reason to believe that this David Van Risseghem guy has a real connection to Stitt such that he might know what he is talking about?

Bunty
07-01-2020, 12:08 PM
Gov. Stitt said about passage of SQ802, "We have a billion-dollar shortfall next year. The state would have to either raise taxes or cut services somewhere else like education, first responders, or roads and bridges".

But Gov. Stitt doesn't know what he's talking about. At least two sources of funding have been identified to pay for SQ802. They are raising the Supplemental Hospital Offset Payment Program (SHOPP) fee on hospitals and earmarking a large share of tobacco settlement revenues by passage of SQ814.

Stitt even vetoed his new Soonercare plan that would be funded by raising SHOPP fee. It goes to show you how the state doesn't have good leadership from the governor on this issue. He hardly seems to want to lead at all.

Bunty
07-01-2020, 12:09 PM
That looks like some random dude's blog, is there any reason to believe that this David Van Risseghem guy has a real connection to Stitt such that he might know what he is talking about?

I don't know, but I regard him as a conservative political activist. Interestingly enough, he supported legalizing medical marijuana.

GoGators
07-01-2020, 12:28 PM
Gov. Stitt said about passage of SQ802, "We have a billion-dollar shortfall next year. The state would have to either raise taxes or cut services somewhere else like education, first responders, or roads and bridges".

But Gov. Stitt doesn't know what he's talking about. At least two sources of funding have been identified to pay for SQ802. They are raising the Supplemental Hospital Offset Payment Program (SHOPP) fee on hospitals and earmarking a large share of tobacco settlement revenues by passage of SQ814.

Why wasn't he worried about the billion dollar shortfall when he was out buying 2 million dollars worth of snake oil?

GoGators
07-01-2020, 12:40 PM
That looks like some random dude's blog, is there any reason to believe that this David Van Risseghem guy has a real connection to Stitt such that he might know what he is talking about?

Yea, the article is clearly not legitimate in any way. Just ramblings of some guy. The vast majority of the article is just him saying what he believes someone should do. the only mention of Stitt is one vague sentence.

"The Governor is expected to call on AG Mike Hunter to seek a court injunction for a stay of the certification, until an investigation can be completed."

Yes i'm sure he expects Stitt to do this in his mind. This article is just conspiratorial fan fiction.

jerrywall
07-01-2020, 12:59 PM
Why wasn't he worried about the billion dollar shortfall when he was out buying 2 million dollars worth of snake oil?

I mean, that wasn't State money... it was Federal funds, IIRC. According to all the yes on 802 ads that's free money that we've been letting the evil states like "California" get instead, so who cares if it's wasted? Shouldn't we spend it before they can? :D

GoGators
07-01-2020, 01:09 PM
I mean, that wasn't State money... it was Federal funds, IIRC. According to all the yes on 802 ads that's free money that we've been letting the evil states like "California" get instead, so who cares if it's wasted? Shouldn't we spend it before they can? :D

The feds paid for the 2 million worth of hydroxychloroquine? That would be news to me.

Did the Feds reimburse Oklahoma or did they pay FFF Enterprises directly on Oklahoma's behalf?

jerrywall
07-01-2020, 01:13 PM
The feds paid for the 2 million worth of hydroxychloroquine? That would be news to me.

I was actually making a joke, but yeah, it was Fed money, if I recall correctly.

GoGators
07-01-2020, 01:16 PM
I was actually making a joke, but yeah, it was Fed money, if I recall correctly.

Im pretty sure the Oklahoma State Department of Health wrote that check. Unless the Feds came in and reimbursed the state after the fact which could be possible and i hope happened.

jerrywall
07-01-2020, 01:23 PM
Im pretty sure the Oklahoma State Department of Health wrote that check. Unless the Feds came in and reimbursed the state after the fact which could be possible and i hope happened.

Stitt stated it was part of the $1.2 Billion COVID funds the state got and used to stockpile PPE, ventilators, and drugs.

GoGators
07-01-2020, 01:42 PM
Stitt stated it was part of the $1.2 Billion COVID funds the state got and used to stockpile PPE, ventilators, and drugs.

The CARES Act that's right. Now the joke makes sense to me.

soonerguru
07-01-2020, 02:39 PM
So grateful this passed! Obamacare was flawed but it is also basically sound. Its opponents have demonized it but failed to deliver workable alternatives. It is telling that at this point even the State Chamber is on board with it in the absence of literally anything else. It is embarrassing that the voters had to take this matter into their own hands due to a stunning lack of leadership on healthcare in this state under Fallin and Stitt.

Jersey Boss
07-01-2020, 02:57 PM
So grateful this passed! Obamacare was flawed but it is also basically sound. Its opponents have demonized it but failed to deliver workable alternatives. It is telling that at this point even the State Chamber is on board with it in the absence of literally anything else. It is embarrassing that the voters had to take this matter into their own hands due to a stunning lack of leadership on healthcare in this state under Fallin and Stitt.

As I recall Mary was for it initially when she won the first time, but was spanked by legislative leadership.

Laramie
07-01-2020, 06:52 PM
Long overdue for lower income persons to get many times more funds to all Oklahoma hospitals; especially those hanging by a thread in rural Oklahoma. Hope they can reopen some of the previously closed hospitals.

Hope we'll see the gravity of the June 30th election and the additional benefits (out weight investment) to Oklahoma's future.

We've been supporting other states with Medicaid expansion and getting little if anything in return.

SoonersFan12
07-02-2020, 01:04 PM
Barely, but I'll take it.

I would not call passing by 6,518 votes barely, if it passed by between 50 to 200 votes then that is barely