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SoonerCare update

SoonerCare update. Interim study- Senate HHS- Sep.29, 2014. WHO. WHO. WHAT. State and federally funded health care coverage Federal authority is under titles XIX and XXI of Social Security Act . State authority exists in titles 56 and 63 of OAC.

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SoonerCare update

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  1. SoonerCare update Interim study- Senate HHS- Sep.29, 2014

  2. WHO

  3. WHO

  4. WHAT State and federally funded health care coverage Federal authority is under titles XIX and XXI of Social Security Act. State authority exists in titles 56 and 63 of OAC. 3. State legislature has to actively approve OHCA agency rules. 4. Further, in order to receive federal financial participation, authority has to exist in 1 of 2 documents: waiver or state plan.

  5. WHEN • Providers • Process claims in seconds and pay over 900,000 claims every Wednesday. • Provider portal allows providers to make changes and submit documentation or claims in an automated environment. • Members • Pregnant women, parents and children are eligible to apply 24/7 on mysoonercare.org, the nation’s first real-time, automated online enrollment system. • Bookend health coverage- beginning and end of life.

  6. WHERE

  7. WHY • Created in 1965 with the specific purpose of health coverage of those without direct access to traditional source of insurance (AFDC) to be paired with Medicare (aged) • Now provides critical health protection for key vulnerable/high risk populations • Low-income families with children and people with disabilities • Long-term care for older Oklahomans and people with disabilities • Supplemental coverage for low-income Medicare beneficiaries • Supports state’s health infrastructure • Different optional expansions over the years • 1997- expanded coverage to pregnant women and some kids • 2005- Insure Oklahoma was created to offer subsidies for small businesses and their employees

  8. HOW • SoonerCare Choice, Oklahoma’s own Patient Centered Medical Home program, seeks to transform delivery of health care through: • Interdisciplinary team approach to care coordination • Standardization of care in accordance with evidence-based guidelines • Tracking test and consultations and follow-up after ER/hospitalizations • Active measurement of quality and adoption Quality Improvement strategies

  9. HOW

  10. HOW

  11. BUDGET REDUCTIONS

  12. INSURE OKLAHOMA

  13. Contact and resources Carter Kimble Director of Government Relations 405.522.7510 Carter.Kimble@okhca.org www.okhca.org www.insureoklahoma.org

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