Skip to main content

Advanced Search

Advanced Search

Current Filters

Filter your query

Publication Types



Newsletter Article


Oklahoma: Enhancing Access Through Medicaid Rate Increases and Medical Homes

Over the past five years, Oklahoma has used a combination of rate increases, outreach, administrative simplification, and a medical home initiative to enhance access to care in SoonerCare, the state's Medicaid program.

In 2005, Oklahoma increased its Medicaid reimbursement to 100 percent of Medicare rates—a substantial increase from rates that were 28 percent below Medicare levels in 2003. The Oklahoma legislature appropriated additional funds specifically for a rate increase. This change occurred during a period when Medicaid rates across the country were growing more slowly than inflation. From 2003 to 2008, Medicaid fees increased an average of 15.1 percent nationally, but because their overall growth was below the rate of inflation this actually amounted to a decrease in their real value.

According to Medicaid Director Lynn Mitchell, M.D., the board of the Oklahoma Health Care Authority (OHCA), which administers Medicaid, had for years recognized the need to keep provider payment rates fair and competitive, and accordingly made this a top priority in several years of strategic planning. As the Medicaid program grew and increasingly became a line of business for a wider range of providers, the need for this type of accountability continued to increase. "A great deal of effort was focused on the rate increase, both in terms of a potential legislative agenda, and in working with our partners in the state medical, osteopathic, and hospital associations," Dr. Mitchell said.

The Medicaid program also sought to promote access to care through expanded outreach efforts and improve its relationships with providers by reducing their administrative burdens. As a result, it has not been possible to isolate the impact of the rate increase on access to care, though Dr. Mitchell noted that providers' response to the increase has been very positive.

As in many states, Oklahoma has struggled to preserve its Medicaid rates in the current economic environment. After extensive efforts to avoid a rate cut, the OHCA took action to make a 3.25 percent reduction in provider rates starting April 2010, though Dr. Mitchell noted that the situation could change before it takes effect. Oklahoma still views the rate increase as a successful effort, noting that OHCA's board continues to focus on preserving rates and rebounding from any cuts as soon as economic conditions allow.

In the past few years, the Medicaid program's efforts to establish and promote medical homes have become a major policy priority. Interest from the provider community has led OHCA, in collaboration with providers, to develop an enhanced payment model for medical homes in the existing SoonerCare Choice program (in which most Medicaid members are enrolled). The new model was implemented in January 2009 under a Section 1115a waiver. The change shifted the program away from a partially capitated managed care model to a monthly payment for care coordination and case management, in combination with a fee-for-service component for office visits. The care coordination fee is set based on characteristics of the practice and populations that providers serve, and also on the practice's sophistication as a medical home, ranking its capabilities in three tiers from "entry level" to "optimal."

The model also includes a pay-for-performance bonus program. Advanced registered nurse practitioners and physician assistants can qualify as medical home providers, and the state has a wide variety of practice sites participating. OHCA Provider Services Director Melody Anthony said the transition has been successful so far. "The provider community has been very supportive, and a large percentage of providers are qualifying for bonus payments under the new SoonerExcel pay-for-performance program," she says.

Oklahoma's Medicaid leaders have learned that rate increases alone are not sufficient to address access to care and provider participation. It has been crucial for the state to work with partners and make the improvements explicit priorities. "It took a lot of outside help to move these efforts forward from the standpoint of legislative progress and dollars," Dr. Mitchell said. "And we did not look to just one area to be the answer."

For more information, contact Melody Anthony at [email protected].

Publication Details