The administration of Oklahoma's Republican Gov. Kevin Stitt has asked the CMS for approval to expand Medicaid to low-income adults under the Affordable Care Act as soon as July 1.
Stitt told the Oklahoman newspaper Thursday that after submitting the state plan amendment, the state will follow up with the Trump administration to seek waivers to allow the state to impose premiums and work requirements on expansion enrollees under his proposed SoonerCare 2.0 plan.
In addition, he said the state will seek CMS approval for waivers to convert the state's Medicaid program into a capped federal funding model under the Trump administration's newly announced Healthy Adult Opportunity program. He wants to shift beneficiaries into private Medicaid managed care plans.
A spokeswoman for the Oklahoma Health Care Authority confirmed that the agency submitted the state plan amendment to the CMS on Friday.
Stitt is racing to get ahead of a ballot initiative that would establish a straight Medicaid expansion, without work requirements or premiums, for all adults up to 138% of the federal poverty level. That ballot initiative, which would amend the state constitution, has garnered enough signatures for voter consideration this year. The Oklahoma Hospital Association supports the measure.
Oklahoma would become the 38th state to implement Medicaid expansion. Idaho and Utah currently are enrolling people in their expanded programs, which were mandated by voters in 2018. In Nebraska, GOP elected officials have delayed that state's voter-approved expansion. Maine voters approved expansion in 2017, and it was implemented last year.
There is also a petition drive underway in Missouri to put Medicaid expansion on the ballot in November, which the Missouri Hospital Association supports. An estimated 230,000 residents could qualify for coverage.
Polls have shown a majority of Oklahomans support Medicaid expansion. An estimated 200,000 low-income adults could quality for Medicaid coverage under the expansion.
Stitt, who opposes the ballot initiative, has to decide when to place State Question 802 on the ballot, whether this spring or in November.
He is trying to cobble together a deal with hospitals and lawmakers on how to fund the state's 10% share of expansion costs, estimated at $150 million a year.
Stitt wants to raise a state fee on hospitals to help fund the expansion, but hospitals say they wouldn't be able to budget for that large a fee increase this year.
Patti Davis, president of the Oklahoma Hospital Association, said her organization appreciates the governor's effort to expand Medicaid by July 1 but that raising the hospital fee by $134 million to fund most of the first-year costs is excessive.
"We do not want to put a disproportionate burden on vulnerable rural hospitals," she said.
The leader of a union-backed group helping organize and fund the Oklahoma and Missouri ballot initiative efforts said the only reason Gov. Stitt is moving ahead on Medicaid expansion is because of the likely success of the ballot initiative. He called Stitt's moves to establish premiums, work requirements, and federal funding caps "a bait and switch."
"The governor may expand Medicaid then aggressively work to undermine it through block grants and work requirements," said Jonathan Schleifer, executive director of the Fairness Project. "But voters will have the power to put it in the state constitution and block him from doing those things."