The Oklahoma Health Care Authority (OKHCA) is an agency of the government of Oklahoma responsible for providing health insurance benefits for the state’s SoonerCare (Oklahoma Medicaid) members. The Authority is the state-level counterpart to the federal Centers for Medicare and Medicaid Services.
The Authority is led by a Board of Directors, composed of seven members appointed by the Governor of Oklahoma, the President pro tempore of the Oklahoma Senate, and the Speaker of the Oklahoma House of Representatives. The Board in turn appoints the Administrator of the Authority, who serves as the chief executive officer of the Authority.
The Authority was created in 1993 during the term of Governor David Walters.
The Oklahoma Health Care Authority is led by the Secretary of Health and Human Services. Under Governor of Oklahoma Mary Fallin, the Secretary of Health and Human Services is Dr. Terry Cline, Ph.D..
The Board of Directors is the governing body of OHCA, which directs the actions and oversees the operation of the Authority. The Board is composed of seven members, with three appointed by the Governor of Oklahoma, two appointed by the President pro tempore of the Oklahoma Senate, and two appointed by the Speaker of the Oklahoma House of Representatives. Board members serves a four-year term without compensation. In making the appointments, the considerations must be given to urban, rural, gender and minority representation.
As of 2014, the current members of the Board are:
The Oklahoma Health Care Authority has the primary duty of executing SoonerCare, the Oklahoma version of Medicaid. SoonerCare is a health coverage program jointly funded by the United States federal government and the Oklahoma state government. The program provides payments to cover medical services to economically challenged individuals. OHCA determines financial eligibility for the program.
SoonerCare is medical care delivered by OHCA as prescribed by the Social Security Act of 1965 (the Medicaid Act). The Federal Medicaid Act requires that certain medical services be delivered to recipients by hospitals and physicians. The State, however, is allowed to add other optional services, such as pharmacy services. With each of these programs, OHCA is responsible for setting compensation levels, services contained in each delivery system, contracts to deliver the services, and actuarial determinations regarding compensation. As of February 2012, those individuals covered by HCA comprise approximately 879,033 individuals across Oklahoma.
In order to be eligible to receive SoonerCare medical services from OHCA, an individual must meet any of the following requirements:
SoonerCare is a means tested program. State law provides that SoonerCare may cover individuals who have an annual income of equal to or less than 185% of the United States federal poverty level. OHCA contracts with Oklahoma Department of Human Services to determine eligibility for OHCA services. Additionally, OHCA actively works with the Office of the Oklahoma Attorney General’s Medicaid Fraud Unit to prosecute fraudulent providers.
In September 2010, OHCA implemented an online system that uses an “enroll-first, verify-later” approach that automatically renews benefits for existing SoonerCare beneficiaries and enrolls new applicants if the system determines that they are likely to meet eligibility requirements
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. The program has streamlined enrollment processes, saving an estimated $1.5 million in operating costs and reducing the rate of those uninsured.
Insure Oklahoma is an employer sponsored insurance plan administered by OHCA which provides employers with premium subsidies to help buy health insurance for low to moderate income employees. Insure Oklahoma also provides a way for individuals who participate in the Individual Plan to gain access to an affordable health care option.
In April 2004, Senate Bill 1546 authorized the Oklahoma Health Care Authority to develop a program assisting employees of small businesses, 19 to 64 years of age with either:
In November 2004, the Oklahoma Health Care Initiative created the funding mechanism to fund Insure Oklahoma. SQ 713, passed by a statewide vote, increased the sales tax on tobacco products. A portion of these revenues were designated to be used to fund the new health program.
The Authority is divided into four service branches: Soonercare Operations, Financial Services, Information Services, and Legal Services.
The Oklahoma Health Care Authority has an annual budget over $5 billion, making OHCA one of the largest state agencies. OHCA also employs over 400 full-time employees.