The Oklahoma Health Care Authority will hold a public hearing at 1 p.m. Monday, Nov. 2, to discuss proposed permanent rules on Medicaid work requirements, coverage of gender-affirming care and increased eligibility redeterminations.
The public hearing will be held in the Charles Ed McFall Board Room at the state Medicaid agency’s office in Oklahoma City. Health Care Authority Spokesperson Rebecca Sheppard said in an email that the Health Care Authority’s policy team will review eight rules, which the agency’s board will vote on at its December meeting.
Individuals must sign in at the door by 1:05 p.m. and will be allowed two minutes to speak. Online comment for each rule is also available here. Virtual streams will not be provided.
The Health Care Authority is preparing to implement several policies under H.R. 1, President Donald Trump’s massive spending and tax bill, which was signed into law last year.
Proposed permanent rules eligible for public comment during the meeting include 80-hour-per-month work requirements for certain Medicaid recipients and more frequent eligibility redeterminations – on a six-month basis instead of annually.
Both will impact Oklahomans ages 19 to 64 covered under Medicaid expansion, which includes 247,315 adults making up to 138% of the federal poverty level, or $22,025.
H.R.1 directs states to implement both policies by Jan. 1, 2027.
Qualifying hours for work requirements can be earned through employment, community service, and work and educational programs. Medicaid expansion adults can also meet them by demonstrating a minimum monthly income of $580.
The Health Care Authority will first use information on file to determine whether a member meets work requirements or qualifies for an exemption. Examples of exempted populations include pregnant and postpartum women, American Indian and Alaska Native Oklahomans, and blind or disabled individuals.
If the Health Care Authority needs more information, it will send a notice. Individuals will have 30 days to respond and, if they do not provide the necessary information, they could lose coverage.
If someone applies for Medicaid or renews their coverage for the first time next year, they must show compliance with work requirements in the month before. At their second renewal, the member must show compliance for any month before their renewal.
For example, if a member is renewing their Medicaid coverage in August 2027, they must show compliance for July 2027. For that same member’s second renewal in February 2028, they would need to show compliance in any month from August 2027 through January 2028.
The agency estimates work requirements will cost $12,445,990 in implementation and compliance costs over two years. This includes anticipated system development, administrative operations, eligibility verification, notices, outreach and other activities necessary to implement the federally mandated requirements.
Increased eligibility redeterminations will not apply to American Indian and Alaska Native populations, according to a proposed permanent rule from the Health Care Authority. The groups will remain on a 12-month redetermination cycle.
The policy change will also reduce retroactive eligibility periods to comply with H.R. 1. Oklahoma can currently cover medical expenses up to three months before Medicaid applicants submit their request for coverage. Under the new rule, Medicaid expansion adults will be eligible for one month of retroactive eligibility, and non-Medicaid-expansion populations will be eligible for two months.
American Indian and Alaska Native Oklahomans are not excluded from this provision.
The Nov. 2 public hearing will also cover policy changes fueled by state legislation. Senate Bill 904, which became law this year, prohibits coverage of gender-affirming care under the state Medicaid program. The Health Care Authority board approved an emergency rule in compliance with the legislation.
Oklahoma already banned these services for people under 18 in 2023. This law extends to adults. It also bars public funds from being used to provide or subsidize gender-affirming care and prevents state properties, facilities and buildings from being used to deliver it.
The proposed permanent rule is estimated to create approximately $103,697 in annual savings, including $35,247 in state dollars, due to nonpayment of claims prohibited by state law.
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