| December 20, 2012

New OHCA CEO should embrace and champion reform

The Oklahoma Health Care Authority will soon have a new Chief Executive Officer. The OHCA is the state’s chief Medicaid agency and has seen significant cost and enrollment growth over the last decade, facing significant funding challenges in the future just to maintain the status quo, much less expand.

I recently noted in an op-ed for the Oklahoma Gazette:

…The availability of current or promised levels of federal Medicaid funding is uncertain. President Obama’s Fiscal Year 2013 budget proposes cutting federal Medicaid assistance and his deficit reduction plan cuts future federal Medicaid assistance…

…Federal lawmakers from both major parties have endorsed future cuts to federal Medicaid assistance…”“According to the Oklahoma Health Care Authority, Medicaid spending in the state in 2001 totaled $2 billion. For 2011, it’s $4.4 billion, a 120-percent increase. The state’s share was $495.5 million in 2001 and has increased to over $1.29 billion, a 161-percent increase. State 2000 appropriations to the OHCA were $333.7 million and approximately 6.8 percent of total state appropriations. For 2011, appropriations to it were $993 million and nearly 15 percent of total state appropriations.

Maintenance of effort increased state lawmaker appropriations and authorizations by $80 million for FY 2013, and Medicaid received the largest increase for 2013. …

According to recent budget requests, the OHCA is seeking appropriated increases of more than $105 million.

As OCPA has previously noted:

According to the state’s Comprehensive Annual Financial Report (CAFR), state spending on Medicaid is devouring more and more of the state budget. According to pages 164-165 of the CAFR, in FY-2005 spending on education totaled $3.534 billion and made up 30.13 percent of total state spending. State spending on health services (mostly Medicaid) totaled $3.144 billion and made up 26.81 percent of total state spending.

Fast forward to FY-2011, and spending on education totaled $4.572 billion and made up 27.47 percent of total state spending. State spending on health services (mostly Medicaid) totaled $4.851 billion and made up 29.15 percent of total state spending. So according to the CAFR:

  • Total state spending on education has grown 29.4 percent in six years, yet
  • Total state spending on health services has grown 54.3 percent in six years.

According to the CAFR, total state spending at the Oklahoma Health Care Authority (OHCA), the state’s primary Medicaid agency, is $4.413 billion. This surpasses total state spending by the state Department of Education (common education) and Higher Education combined, which is $4.270 billion.A review of OHCA statistical information reveals that in August 2001 total Medicaid enrollment (eligibility) was 449,860. Total Medicaid enrollment for July 2012 was 797,753, an increase of 347,893 or 77.33 percent. According to the OHCA FY-2011 Annual Report, for FY-2011 there were 968,296 unduplicated members enrolled in Medicaid in Oklahoma. According to the OHCA, Medicaid covers approximately 64 percent of births in Oklahoma and at least 30 percent of the population in 30 counties.

To say that it is time to reform Medicaid is an understatement. Significant, patient-centered Medicaid reform, such as adopted in Florida, must happen in Oklahoma to provide necessary relief to Oklahoma citizens and preserve funding for other core services. Governor Mary Fallin has wisely called for serious reform.

Desperately needed Medicaid reform will only happen if it is embraced by OHCA employees and their future CEO. Attitude reflects leadership, personnel is policy. Soon the Board of the OHCA will appoint a new CEO—only candidates serious about reform need apply. The new OHCA CEO should embrace and champion significant Medicaid reform; the status quo is not an option.

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