If policymakers wish to increase reimbursement rates or shift higher-income enrollees out of Medicaid, they can do so without expanding Obamacare whatsoever. In fact, expanding Medicaid under Obamacare will make any other Medicaid reforms even harder to achieve.

OHCA has consistently fought efforts by policymakers to better manage and coordinate the care of those currently relying on Medicaid, including seniors, poor children, pregnant women, and individuals with disabilities. OHCA has also fought efforts to protect program integrity by ensuring that those receiving Medicaid actually belong there. In fact, OHCA staff has even boasted to their peers in other states about their ability to kill previous efforts by lawmakers to reform Medicaid.

Instead of expanding Medicaid to a new class of able-bodied adults, policymakers should refocus their efforts on improving the program for those it was meant to serve: the truly needy. Lawmakers have a number of policy tools at their disposal to improve the program, and none of them require implementing Obamacare’s Medicaid expansion. For example, lawmakers could:

• Decouple and adjust the various provider rates based on need, so that critical services like nursing home care, rural primary care, rural hospital care, and other critical services with limited revenue streams can be prioritized for funding. Given it would take just $10 million to protect nursing homes from harmful cuts, thorough analysis reveals affordable state-based solutions can be effective.
• Implement the Medicaid reform pilot program which was passed by the legislature in 2015 and which special interests tried to repeal during the 2016 legislative session.
• Restructure OHCA into a cabinet-level agency with the CEO and Medicaid director appointed by the governor and reorganize the OHCA board into an advisory board. This will allow operational decisions to be made unclouded by the pressure special interests currently wield on OHCA and will improve the overall effectiveness of the agency, just as lawmakers improved the Oklahoma Department of Human Services.
• Utilize 21st-century tools to protect program integrity and ensure that only those actually eligible are enrolled in the program. Illinois saved an estimated $350 million per year by implementing such a program. Oklahoma’s Medicaid program could save an estimated $20 million per year by implementing a similar program.
• Encourage local communities to increase local support and local financing for health providers that are struggling.
• Extend Medicaid reform efforts to other populations currently enrolled in Medicaid. Further coordination of care, greater use of health plans to better manage care, and increased use of capitation could save more than $80 million, based on other states’ experience.