HEALTH CARE AUTHORITY

 

Implementation of managed health care for AFDC (now TANF) recipients in rural Oklahoma began in late 1997 using a primary care, case management model of service delivery. The Legislature doubled the case management fee paid to primary care physicians in FY'98 to make participation in the program more attractive to providers.

The Legislature provided $1.6 million for federal mandates on Medicaid eligibility of children (ages 0-14) living in families at or below the poverty level. An additional $5.04 million was appropriated to expand eligibility for children in families up to 185% of poverty level (SB 639). Also, the Health Care Authority was authorized to pursue a federal waiver for a "buy-in" option for Medicaid health care services for other working poor families.

 

The Legislature funded $800,000 for Medicare Part A (hospital) and Part B (physician) premium, deductible and copayment increases. Medicaid must pay these increases for elderly and disabled persons whose low incomes make them eligible.

Increases in the fee-for-service vendor drug program resulted in the Legislature appropriating an additional $2.1 million to cover costs of prescription drugs for Medicaid clients in FY'98.

The Boren Amendment requires Medicaid to pay cost-of-living adjustments in fee-for-service hospital payments. $1.9 million more was appropriated for this mandate in FY'98.

The Legislature provided $7.8 million for cost-of-living adjustments to nursing homes and ICFs/MR, required by the Boren Amendment. This amount includes the cost of the federal minimum wage increase effective October 1996. An additional $6.2 million was appropriated to annualize the $1 per hour wage increase for LPNs, aides, and social service/activities staff at nursing homes that began in May 1997.

To increase participation of dentists in the Medicaid program, particularly in rural areas, rates were increased to 75% of the rate paid to dental providers in the state employee plan.

Payments to community health centers for Medicaid services were increased by $200,000 by the Legislature.

In recognition of the additional cost of providing physician services in a teaching environment, payments for Medicaid services provided in a medical education setting were nearly doubled in FY'98. This funding will help support the OU Health Sciences Center and the School of Osteopathic Medicine in Tulsa.

 

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