© 2024 KGOU
Oklahoma sunset
News and Music for Oklahoma
Play Live Radio
Next Up:
0:00 0:00
Available On Air Stations

How Oklahoma’s transition to managed Medicaid happened and what’s next

The Oklahoma Health Care Authority manages Oklahoma's Medicaid program, known as SoonerCare.
The Frontier
The Oklahoma Health Care Authority manages Oklahoma's Medicaid program.

Most of Oklahoma’s Medicaid population is transitioning to managed care. This means that instead of the Oklahoma Health Care Authority paying providers directly, it’s paying private companies to coordinate some enrollees’ care. Proponents say the new system incentivizes better preventative care, which could cost the state less in the long run.

That transition has been decades in the making.

StateImpact’s Jillian Taylor spoke with Lou Carmichael, the CEO of Variety Care, one of Oklahoma’s largest community health centers serving Medicaid recipients, about how it all happened.


Jillian Taylor: So let's start by backing up and outlining what we're talking about today — managed Medicaid or SoonerSelect. What is that, and how is it different from what some of us might know as SoonerCare?

Lou Carmichael: SoonerCare is the Medicaid program the state of Oklahoma administers on behalf of beneficiaries, and managed Medicaid is now the model of care that Oklahoma has embarked upon — both the dental program as well as the medical program. And its purpose is to manage care better through a different model than just direct contracting.

Taylor: This transition to managed care has been a long time coming. When was it first considered?

Carmichael: (We) had managed Medicaid back in the 90s, and that did not work out very well for the state of Oklahoma. We (have) been in a traditional Health Care Authority (administered) program (since that system ended). The conversations then in Gov. Stitt’s first term in office began to happen, and the idea there was that we would send out requests for proposals to different managed care organizations to move the state to managed care. That also happened at the same time the state was thinking about expanding Medicaid. … And so when the voters in Oklahoma voted to expand Medicaid, the governor sent forth his first direction to the Health Care Authority to accept proposals to shift our health care delivery to managed care.

Taylor: How did that go? Tell me a little bit more about that.

Carmichael: Well, the request for proposal was submitted, (and) we went through the process … and in that process, there was a protest … saying that … the state had not gone through the right process, and that they needed legislative authority in order to move to a managed care model. And so, at that time… I don't think we ever got to signing (the contracts), actually, and so that idea went away. The Legislature had to come back into session, I believe, the next year, in order to give the governor permission to have the Health Care Authority move to managed care. And then the process began again.

Taylor: What entities did Oklahoma end up contracting with for managed care?

Carmichael: So DentaQuest and LIBERTY Dental were selected for the dental. That went live in February. And then the medical … was Aetna, (Oklahoma Complete Health) and Humana. So those three organizations were the highest scoring and received a bid.

Taylor: What populations made it onto what we now know as SoonerSelect?

Carmichael: So SoonerSelect includes pregnant women, children and the (Medicaid) expansion population. … The group that did not go into managed care at this time are the ABD population — or aged, blind and disabled — and that population is not included in SoonerSelect.

Taylor: Tell me about the timeline of the rollout of managed care until April 1. What has that looked like so far?

Carmichael: Notices went out to beneficiaries … that there were changes coming, and that they would need to select a dental provider by February when dental went live, and then by April when the medical programs went live.

Taylor: And it’s been a little over a month since the transition. What comes next?

Carmichael: On April 1st, if they hadn't made a selection, then a plan was selected for them. Once the plan was selected by the patient or the patient was put into a plan, then the patients needed to pick the provider that they wanted. … And they will have until July 1st to change plans or change providers. And then once we get to July 1st, the changing around will be a little bit more limited and a little harder to do. But between now and July, patients still can opt between different plans and different providers.

Taylor: That’s Lou Carmichael from Variety Care. Thanks so much for speaking with me.

Carmichael: You’re welcome, it’s great to talk to you.

This transcript has been lightly edited for clarity.

StateImpact Oklahoma is a partnership of Oklahoma’s public radio stations which relies on contributions from readers and listeners to fulfill its mission of public service to Oklahoma and beyond. Donate online.

Jillian Taylor reports on health and related topics for StateImpact Oklahoma.
StateImpact Oklahoma reports on education, health, environment, and the intersection of government and everyday Oklahomans. It's a reporting project and collaboration of KGOU, KOSU, KWGS and KCCU, with broadcasts heard on NPR Member stations.
More News
Support nonprofit, public service journalism you trust. Give now.