OKLAHOMA CITY — The Oklahoma Health Care Authority is celebrating what it says is the success of the SoonerSelect program three months after its rollout, despite growing concerns about delayed payments for health care providers.
The transition from a fee-for-service to a managed-care model has been touted by the Oklahoma Health Care Authority as a way to improve patient outcomes and save the state money. But health care providers, especially rural providers, say they are getting the short end of the stick.
“They haven’t been getting paid, or what’s become the case recently is that they’re rejecting their claims and not paying out the claim,” said state Sen. David Bullard, R-Durant.
Bullard highlighted the issue in a press conference earlier. He says the rollout was not planned well and that health care providers were not trained on how to use the new system or given parameters for the care to be offered. The Health Care Authority, which manages the state’s Medicaid program, has said all covered benefits remain the same as they were in the previous SoonerCare program, although each plan offers extra benefits.
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“The real problem is the agency can say that they’ve done a good job of implementing this,” Bullard said. “But what the providers in the field are saying is that they’re not doing their job; they’re not paying out; they’re not communicating; they’re not answering their phones. It has not been rolled out well.”
SoonerSelect was rolled out on April 1 and is now used by more than 600,000 Oklahomans, according to the agency.
SoonerSelect has paid out more than $230 million in Medicaid claims since April 1, which included $71 million to hospitals, $31 million to behavioral health practitioners, and $100 million to physicians and nurse practitioners.
The agency says it has recognized an isolated issue with a specific provider system and has found a solution, which means payments have begun to be distributed to providers affected by the issues.
But Bullard says many of the claims filed by health care professionals have not been paid, leaving them in limbo. Bullard says some of the professionals who have shared their concerns with him are considering moving to another state, where they can actually get paid, or just retiring.
“This is a failure until they’re willing to admit that they did not roll this out correctly; … this is going to continue to get worse in the coming weeks,” Bullard said.
SoonerSelect includes what the Health Care Authority calls “enhanced payments,” which is money from the government not attached to any care covered through insurance companies. The agency announced in April that the first $252.4 million in enhanced payments had been paid to Oklahoma hospitals. Hospitals can expect around $500 million in supplemental payments from the Health Care Authority annually.
But, Bullard pointed out, if all the providers are leaving or retiring, it doesn’t matter how much money the hospital has. Loss of health care providers is a particular concern in rural Oklahoma, where there are already too few doctors.
“Rural health care right now is in danger. We’re at risk of losing a lot of providers across rural Oklahoma right now,” said Bullard.
The Health Care Authority says there were months of town hall meetings and trainings with providers before the launch of the program. If any providers have more questions or concerns, the agency says they can seek help on the issue found under provider resources at the agency’s website.
Gov. Kevin Stitt said in a Health Care Authority press release that “Medicaid reform isn’t optional.” The governor has pushed for some form of managed care for Medicaid since 2021, though his original attempts to implement managed care were struck down by the Oklahoma Supreme Court.
“I am proud of the way OHCA has managed this transition, and while there will always be bumps in the road when rolling out programs of this size, (CEO) Ellen Buettner and OHCA have been responsive and strategic in rolling this out,” Stitt said.
The agency says that broadly speaking, providers in Oklahoma are being paid and that Oklahoma is one of the only states to provide financial assistance for health care providers during the transition period.
The agency emphasized its commitment to making sure the program functions well and that patients and health care providers in Oklahoma are well taken care of.
“OHCA remains committed to holding each (managed care provider) accountable to ensure compliance with state, federal and contractual obligations, prioritizing the well-being of our members,” said Emily Long, the agency’s public information officer.
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