OK Submits Healthy Adult Opportunity Waiver to Expand Medicaid

Oklahoma is the first state to officially request a Healthy Adult Opportunity demonstration waiver to expand its Medicaid program using the new block grant system.

According to an announcement from the Oklahoma Health Care Authority (OHCA), the state is seeking to expand its Medicaid program for adults ages 19 to 64 years old with income less than 133 percent of the federal poverty line, who do not otherwise qualify for Medicaid.

The Healthy Adult Opportunity waiver would also implement work requirements, provide value-based reimbursement to providers, and charge beneficiaries monthly premiums based on household income and the number of people in the household participating in the demonstration.

“This is another step in our SoonerCare 2.0 plan to reduce the number of uninsured Oklahomans and improve health outcomes while still maintaining fiscal responsibility for Oklahoma taxpayers,” Governor J. Kevin Stitt stated in the announcement. “Even during this time of immense change due to the COVID-19 pandemic, it is important to move forward in our efforts to create a healthier Oklahoma.”

The Healthy Adult Opportunity is an optional demonstration initiative launched by CMS earlier this year. The demonstration waivers provide a type of block grant to approved states to expand and administer Medicaid with greater flexibility.

Experts have criticized the Healthy Adult Opportunity, arguing that the block grant funding mechanism will not lower Medicaid spending and could create barriers to enrollment for individuals.

However, Oklahoma policymakers believe the federal funding from the initiative would allow the state to expand its Medicaid program.

“Maximizing federal funding allows the state to invest more in services such as treatment for opioid addiction and improved rural health care," said OHCA CEO Kevin Corbett. 

SoonerCare 2.0 would expand Medicaid in Oklahoma to approximately 220,000 low-income adults who would not otherwise qualify for coverage starting July 1, 2020. The newly eligible population would have access to the same benefits as the current SoonerCare population but would face additional requirements for coverage, per the Healthy Adult Opportunity demonstration waiver.

Under the waiver, the expansion population would have to adhere to community engagement requirements, including work requirements, and pay a monthly premium largely based on household income. The premiums would be no more than $10 per individual and $15 for families.

Groups such as pregnant women and those seeking treatment for severe mental illness or substance abuse disorder would be exempt from community engagement requirements.

“Research shows that individuals who are employed, volunteer in their communities or pursue educational or vocational activities are generally healthier,” Corbett said. “Incentivizing these engagement activities can lead to enhanced psychological well-being and reduce the negative health impacts of economic hardship.”

With the Healthy Adult Opportunity demonstration waiver, Oklahoma would also be able to offer other benefits to the expansion population, including incentive programs for healthy behaviors, mental health offerings, and telehealth services. The waiver would also promote the transition from fee-for-service to value-based care in the state’s Medicaid program.

Overall, top Oklahoma officials expect SoonerCare 2.0 to reduce Medicaid spending and improve outcomes. Specifically, officials anticipate the expanded opportunity to:

• Reduce the number of opioid-related overdose deaths
• Decrease the incidence of childhood obesity
• Improve access to community behavioral health care services
• Encourage tobacco cessation and reduce tobacco-related illness
• Increase prevention of cardiovascular disease

Failing to meet its goals, the state could lose the modified block grant offered through the Healthy Adult Opportunity. But if approved, Oklahoma would be the first state to leverage the block grant funding opportunity from the Trump administration.

Although, a grassroots campaign to get a more traditional Medicaid expansion as a ballot measure in November’s election is gaining steam in the Republican-led state. The campaign aims to expand Medicaid without work requirements or cost-sharing by a public referendum. Similar efforts have worked in Nebraska, Idaho, Utah, and Maine.