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Oklahoma moves state Medicaid business to these 4 for-profit insurers

On January, 31 The Oklahoman covered a story about the state's Medicaid program moving to for-profit insurance companies, one of them being UnitedHealthcare. Critics claim the move will negatively affect Medicaid members and force physicians to stop seeing patients.

Oklahoma Governor Kevin Stitt announced the state is moving its Medicaid business to 4 for-profit healthcare companies: Blue Cross Blue Shield of Oklahoma, Humana Healthy Horizons, Oklahoma Complete Health (a subsidiary of Centene Corp) and, yep—you guessed it—United Healthcare. According to The Oklahoman, the governor justified the deal by asserting that state leaders have “a moral obligation to make life better for the people that we serve.” We would like to know whose lives will be better in this new managed Medicaid model.

The state has a history of failed implementation of managed Medicaid, and critics have pointed to previous instances where a Medicaid managed care model has limited patient access and choice, forcing many physicians to stop seeing patients. In this model, insurers profit by driving down costs—which they claim they can do by encouraging members to seek more preventive care. But here’s the challenge: Medicaid populations tend to have more chronic illness and more complex care requirements. Many in this population will need treatment, in addition to preventive care. Our prediction? These for-profit insurers (especially United) will find a way to lower payments to physicians and hospitals providing this more complex care, without doing much to actually prevent disease in the Medicare population. Then they’ll say they’re “reducing the cost of care,” and pocket the difference.

For good reason, the new managed care plan faced opposition from legislators and members of the medical community. According to The Oklahoman, the Oklahoma Hospital Association, Oklahoma Dental Association, Oklahoma Pharmacists Association and Oklahoma Medical Equipment Providers Association oppose this new agreement, as well as the Senate minority leader, who raised concerns that this shift happened without input from the legislature. We are seeing the privatization of Medicaid grow at the expense of those most in need of high-quality care. We’ll see how it works out for Oklahoma and if any other states follow suit.

Original Article:

FEB 26, 2021 - Despite opposition from many of the state’s leading medical groups, Oklahoma will outsource care for most of the state’s Medicaid recipients to for-profit health care companies. Gov. Kevin Stitt and state health leaders announced Friday the Oklahoma Health Care Authority will contract with four companies to manage care for more than 700,000 Medicaid beneficiaries in what will be a major overhaul of Oklahoma’s Medicaid program. The agency will spend up to $2.2 billion to privatize the state’s Medicaid program through what is commonly referred to as a managed-care model. The companies will be paid based on set rates that factor in the number of members enrolled each month.

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