Feds grant 1-year waiver for Insure Okla. program
9/11/2013 8:32:40 AM
OKLAHOMA CITY (AP) – The federal government will let the state operate its Insure Oklahoma health care plan for another year to buy state leaders more time to consider an alternative plan to provide coverage to the working poor, Gov. Mary Fallin announced on Sept. 6.

Flanked by state health officials, Fallin called the extension a “great win for the people of Oklahoma.”

“Insure Oklahoma has been around since 2005. It’s been a success for thousands of small businesses that have used it to help their employees purchase insurance,” Fallin said. “It’s been a success for tens of thousands of families of modest means, who would be uninsured without it. Moving forward, I strongly encourage our federal partners to review Insure Oklahoma’s many successes and announce their support for a permanent, ongoing program.”

Insure Oklahoma, which provides coverage to about 30,000 Oklahoma residents through both individual and employer-sponsored plans, was scheduled to cease operating at the end of the year. Federal officials expected many of the recipients to be eligible for Medicaid expansion if they earned up to 138 percent of federal poverty, or about $32,499 for a family of four.

But amid bitter resistance from some Republicans, Fallin rejected both the Medicaid expansion and the opportunity to set up a state-based insurance exchange where Oklahomans could purchase health insurance with federal tax subsidies. Both were offered under the Affordable Care Act, also known as Obamacare.

Instead, Oklahoma residents who earn up to 400 percent of the federal poverty level, or $94,200 for a family of four, will be able to use federal tax subsidies to buy policies online through a federal exchange beginning Oct. 1.

But some state residents, including thousands on the Insure Oklahoma program, would have fallen into a “coverage crater” where they would have been ineligible for tax subsidies or Medicaid.

Under the one-year waiver, about 8,000 individuals currently on Insure Oklahoma who earn between 100 and 200 percent of federal poverty will instead purchase their health insurance through the federal exchange. Some of the co-pays required through Insure Oklahoma also will be reduced, including a $25 co-pay for doctor visits that will drop to $4, said Nico Gomez, director of the Oklahoma Health Care Authority, the state agency that oversees the Medicaid program in Oklahoma.

A spokeswoman for the U.S. Center for Medicare and Medicaid Services said federal officials are urging states to accept billions of dollars in available Medicaid funding made possible through the new federal health care law, which provides 100 percent federal funding for three years and then drops incrementally to 90 percent.

“We look forward to working with Oklahoma and all other states in bringing a flexible, state-based approach to Medicaid coverage expansion and encourage the state to explore these options,” spokeswoman Emma Sandoe said in a statement.

Republican legislators favor the Insure Oklahoma program over Medicaid expansion because individual recipients pay modest co-pays, with the rest of the premiums covered by employer payments in some cases, along with state and federal matching funds.

“There’s some personal responsibility in the plan,” Fallin said.

The state’s portion of the funding comes from a tobacco tax approved by voters and is used to draw down matching federal Medicaid dollars.
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