Oklahoma Medicaid Soon Changing to Managed Care

Posted By: Hayley Twyman Brack Clinical Practice, Insurance Updates,

Oklahoma healthcare authority logo

Pictured above: The Oklahoma Healthcare Authority Logo

Last June, the office of Governor Kevin Stitt announced the intention of the Oklahoma Health Care Authority (OHCA) to solicit proposals from insurance companies to take part in a new managed care initiative, dubbed Sooner Select. Under the managed care plan, the state’s Medicaid program, otherwise known as SoonerCare, will be privatized and many recipients of Medicaid will soon be served by one of four major insurance companies rather than directly through the OHCA.

Last week, Governor Stitt announced that Blue Cross Blue Shield of Oklahoma, Humana Healthy Horizons, Oklahoma Complete Health, and United Healthcare were awarded year-long contracts with the state in a $2.2 billion attempt to revamp Oklahoma’s Medicaid program. According to the OHCA website, the Sooner Select managed care plan is set to take place on October 1st, 2021.

Under the Sooner Select initiative, many populations generally served by Medicaid, including children, foster children, low-income parents, pregnant women, and adults ages 19-65, will soon by served by the Sooner Select Program. However, senior citizens who qualify for both Medicaid and Medicare, individuals enrolled due to their status as aged, blind or disabled (ABD), and some American Indian/Alaskan Native members may still be served under the traditional Medicaid/Sooner Care model.

A phone call was made to OHCA last week for clarification on the new changes. A representative with OHCA confirmed that starting October 1st, most of those who qualify for Medicaid in Oklahoma will be served by one of the four insurance companies who were awarded contracts by the state. The representative stated that if a mental health clinician wished to serve those individuals now covered by Sooner Select, they would have to contract with the four contracted insurance companies. The representative stated the clinician can choose which of the four companies they would like to apply to contract with, but could contract with all four if desired.

The representative also confirmed that OHCA will no longer be managing most populations traditionally served by Medicaid/Sooner Care, including children, foster children, low-income parents, pregnant women, and adults ages 19-65. The representative with OHCA stated that insurance companies have begun sending out packets for current Oklahoma Medicaid/Sooner Care providers to complete in order to contract with the Sooner Select program. It was also advised that if any clinician wished to take part in the new Sooner Select program, that they contact the individual insurance companies for the provider applications.

Being that many mental health clinician licensure candidates in Oklahoma are Medicaid providers, the OHCA representative was asked how the new managed care changes will affect candidates. According to the representative, it will be up to each of the four contracted companies if they will accept candidates as providers in the Sooner Select program. The OHCA representative also advised clinicians to refer to the Sooner Select information page on the OHCA website for continuing updates on the program.