Local health care professionals push back on managed care for Medicaid

Michael D. Smith
The Daily Ardmoreite

With Medicaid expansion set to begin later this year, Oklahoma’s path to join other states that use managed care for Medicaid patients has encountered a new hurdle. Southern Oklahoma health care providers are speaking out against the measure and warn that a plan to outsource the state’s Medicaid management won't  address Oklahoma's current needs. 

Doctors, dentists and behavioral health professionals in Ardmore on Friday instead urged support for an alternative plan currently working through the state legislature that would keep Medicaid administration with the Oklahoma Health Care Authority, including potential managed care. 

“Rural Oklahoma, as we are here in Ardmore and the surrounding area, is going to be especially impacted by this privatization of Medicaid. Bringing in outside insurance companies from out-of-state will just add extra layers of administrative costs,” said Dr. Pamela Kimbrough, Vice President of Medical Affairs at Mercy Hospital Ardmore. 

Dr. Pamela Kimbrough speaks to reporters Friday, April 30, 2021. She said managed care implemented in the 1990s was a failure and would increase administrative costs for health care providers

Kimbrough was joined by other health care providers and administrators at the Lighthouse Behavioral Wellness Center to speak with reporters on Friday. Additional information was provided by Health Care Holdup, a group of 16 organizations representing thousands of medical professionals and patient advocates across the state.

Jessica Pfau, Executive Director of Lighthouse Behavioral, fears the use of managed care organizations to oversee Medicaid in Oklahoma would put further administrative burdens on health care providers. She believes that will directly lead to reduced patient access to mental health care. 

"Mental health care providers typically operate on a shoestring and with extra administrative requirements of the managed care system put in place – and we all know that’s going to happen – the cost of accepting Medicaid patients will rise,” Pfau said. 

Lighthouse Behavioral Health Executive Director Jessica Pfau speaks to reporters Friday, April 30, 2021. She and other area health care professionals are joining a growing coalition opposing the Oklahoma Health Care Authority's plan to contract with private companies to manage Medicaid beginning in October.

Oklahoma voters in June 2020 narrowly approved the expansion of Medicaid under the Affordable Care Act which will go into effect on July 1.

The Oklahoma Health Care Authority in January announced the selection of four managed care organizations to execute Medicaid in Oklahoma beginning in October. The decision, dubbed SoonerSelect, was approved by the OHCA and applauded by Gov. Kevin Stitt as a "step toward improving health outcomes in Oklahoma." 

The Oklahoma Hospital Association, Oklahoma Dental Association, Oklahoma Pharmacists Association and Oklahoma Medical Equipment Providers Association are among the organizations that immediately expressed opposition to the plan. 

Earlier this month, legislation was introduced in the Oklahoma House that would implement changes at OHCA to better manage health care, including payment reforms and in-house managed care. The proposal was approved 73-17 with Rep. Tammy Townley, R-Ardmore, supporting the alternative to Stitt’s SoonerSelect. 

The bill now moves to the Oklahoma Senate for consideration and area health care providers on Friday urged residents to contact their state senators. Lynn Means, executive director of the Oklahoma Dental Association, said the legislature was on board with a plan for OHCA to manage Medicaid expansion until SoonerSelect was introduced. 

“The bill that we have out there, that’s being championed overwhelmingly by the House and is now in front of the Senate, just directs the health care authority to take that plan for a spin and we are 100% behind that idea,” said Means. 

Dr. Mary D. Temple-Goins, a dentist with Storts Family Dentistry and member of the ODA Board of Trustees, estimated between 30% and 40% of her patients are children receiving dental care under Medicaid. She fears that MCOs could dictate what care could be provided to those patients based on billing rates the company is willing to pay, unlike the current Medicaid model that sets standard fees for service. 

Dr. Mary Temple-Goins speaks to reporters Friday, April 30, 2021. She fears private companies contracted to manage Medicaid could dictate what care can be provided to patients based on profitability.

“In addition to having reduced access to dentists, privatization of Medicaid really results in the widespread denial of necessary dental procedures,” said Temple-Goins. “The MCOs will repeatedly tell a dentist that he or she can’t perform a certain procedure because it costs too much.” 

Kimbrough noted a similar attempt at managed care in Oklahoma in the 1990s and said many colleagues recall it as a failure. She and other doctors on Friday said Medicaid expansion is necessary to provide health care to more Oklahomans but the managed care model to oversee that expansion will not improve access to necessary services. 

“We need the expansion, we need to be able to have more patients be able to have Medicaid and we also need the reimbursement to providers to be equitable,” Kimbrough said.