OKLAHOMA CITY — Across the state, health care officials are bracing for the worst.
Without prompt legislative action, they say it will soon start to become more difficult for hundreds of thousands of Oklahomans to find doctors, receive mental health treatment or receive social services.
And, as the third week of special session passed with no apparent budget deal in sight, health officials say fear and frustration are mounting as everyone waits to learn whether lawmakers will fully fund programs that serve some of the poorest and vulnerable Oklahomans.
“It’s a scary proposition right now. People are asking for answers, and we’re not able to give them any. It’s frustrating,” said Nico Gomez, CEO of Oklahoma Association of Health Care Providers, which advocates for nursing homes.
The Department of Human Services, Health Care Authority and Department of Mental Health and Substance Abuse Services are short a combined $215 million after Oklahoma’s Supreme Court ruled that lawmakers illegally passed a tax increase on cigarettes. The money generated by the illegal tax was supposed to fund the three agencies.
Gov. Mary Fallin called a special session to address the shortfall, but in case lawmakers can’t fill the gap she ordered those agency heads to submit revised budgets in anticipation of funding shortages starting in November.
House Appropriations and Budget Chairman Kevin Wallace, R-Wellston, said he is “disappointed” that the three agencies have been asked to make alternative plans for the tobacco shortfall.
“It is clear that the agencies believe they can continue to provide full services and programs to Oklahomans for several months beyond today, so I can only assume these efforts are intended to put pressure on the Legislature to pass the cigarette tax,” he said. “These cuts are unnecessary at this point. Despite all the rhetoric, we have plenty of time to pass a sensible plan that addresses this budget hole in an equitable way.”
The Health Care Authority, though, says it will need to cut Medicaid reimbursement rates by 9 percent starting Dec. 1 to fill the $70 million state funding gap and the loss of $99 million in federal matching dollars, said Jo Stainsby, a spokeswoman for the agency. They’ll hold a public hearing on the proposed rate reductions early next month.
Medicaid is the state’s largest insurer with more than 800,000 — or 1 in 5 — Oklahomans enrolled.
“With rate reductions of this magnitude, there may be degradation of our provider network, which we will closely monitor,” Stainsby said. “We do expect rural areas to be hit particularly hard as they typically have a heavier SoonerCare patient volume.”
The rate cut would be “significantly detrimental” to hospitals, said Craig Jones, president of the state’s Hospital Association.
Already struggling to stay financially solvent, many rural hospitals treat a high number of Medicaid patients, he said.
If Medicaid rates are slashed, Jones said enrollees will struggle to find doctors to treat basic ailments.
Privately insured Oklahomans should then expect to see their own insurance rates increase to compensate for the Medicaid patients who will have no recourse but to show up in emergency rooms for treatment, Jones said.
And if the state shuts down mental health programs, Jones said the mentally ill Oklahomans will show up in emergency rooms or go untreated.
State mental health officials did not return a message left seeking comment about how they planned to balance their budget. The mental health department lost about $75 million, or roughly a quarter of its annual budget.
“We’re just so perplexed that there’s a lot of talk about right-sizing government,” Jones said. “But I don’t hear any legislator talking about what the priorities are. Nobody wants your taxes to go up, but tell me what you want to cut then.”
Department of Human Services leaders will unveil planned cuts later this month, said spokeswoman Debra Martin. The agency is short $69 million in state funds.
There could be cuts coming to programs affecting vulnerable Oklahomans like childcare subsidies, senior citizen programs, home health care and services for those with developmental disabilities, she said.
“Obviously we can’t absorb a $69 million cut,” Martin said. “If we don’t get that (funding restored), then obviously that’s going to be very significant.”
Things are particularly nerve-racking for nursing homes.
“I think we’re at the edge of that cliff, and we’ll see a lot more facilities close,” said Gomez. “If Medicaid drives us down too much, it will make us insolvent.”
Still he’s hopeful lawmakers will come together to avert a crisis.
“I am optimistic they will not allow us to kind of reach this moral crisis that people will die in the streets,” he said. “But the pain is going to be excruciating before we get to that point because it’s the stress of not knowing there’s going to be a plan.
“Our hope is that the moral obligation will win the day,” he said.
Janelle Stecklein covers the Oklahoma Statehouse for CNHI’s newspapers and websites. Reach her at email@example.com.
Okla. health care advocates hope to avoid ‘moral crisis’ | Oklahoma