Oklahoma Attorney General Gentner Drummond has put the state's health care authority on the hot seat over issues plaguing the managed Medicaid care system. Echoing concerns raised by local health care providers, Drummond sent a pointed letter to Oklahoma Health Care Authority (OHCA) Director Clay Bullard, demanding swift action to prevent further erosion of children's access to health care. According to published reports, the Attorney General warned that the current state of affairs could lead to the collapse of pediatric care in all of Oklahoma's 77 counties.
In the letter, Drummond didn't mince words, stating, "Without immediate correction, these failures will destroy Oklahoma’s pediatric network, leaving SoonerCare children across Oklahoma’s 77 counties without access to care." Providers have voiced out about significant reductions in reimbursement for direct pediatric care, among other financial pressures imposed by out-of-state managed care organizations (MCOs). The Attorney General, lending an ear to these grievances, highlighted that nearly half of the SoonerCare enrollees are children who stand at the precipice of losing their health support, not for a lack of need, but a lack of funds flowing to the providers who serve them.
Drummond's critique of the system drew a grim parallel with the infamous challenges faced during the rollout of Obamacare, calling the managed care process under Governor Stitt's administration "an abject, systemic failure." Out-of-state MCOs are under scrutiny for not only delaying payments to community-based providers but also for offering explanations that fail to satisfy the gravity and immediacy of the problem. The MCOs, having had a 15-month transition period, now faced the Attorney General's call for accountability in ensuring timely reimbursements, a key to maintaining a stable health care system.
In light of these issues, Drummond demanded that OHCA provide its contracts with Aetna Medicaid Administrators LLC, Humana Inc., and Centene Corp. The attorney general's office has pressed the authority to review provider reimbursement failures and come up with strategies to address the managed care deficiencies. "If the Authority fails to address the decrease in reimbursement and the failure of MCOs to timely reimburse providers, providers will shut their doors to Medicaid patients and, perhaps, all patients," Drummond emphasized, underscoring the severe consequences that could ripple throughout the state's health infrastructure.
Drummond concluded his correspondence with a stark admonition about healthcare access in Oklahoma. If the authority does not tackle the reimbursement issue or the MCOs' inability to pay on time, the fallout could be devastating, particularly for the rural health sector. He warned that the ongoing crisis threatens to funnel Oklahomans' hard-earned tax dollars into what he describes as "the fog of waste, fraud and abuse" characteristic of the Stitt administration.
