We, the people of Oklahoma, demand that our elected leaders dedicate themselves to finding common ground to provide for the Common Good. Our people are the most valuable resource we have. Oklahoma is at a pivotal point. Will we let our rural areas die, or provide the quality state services needed to save them?
About 2017, many of our rural communities turned to private for-profit health services searching for quality, affordable and accessible health care. They discovered when those companies did not reach their profit goal, they filed for bankruptcy and left the state.
That could have been avoided if Oklahoma had participated in the Medicaid expansion program from its inception. It would have provided a stable funding base for low-wealth families in those rural areas. Finally, on June 30, 2020, a vote of the people approved Medicaid expansion, which provides health care for low-wealth adults between the ages of 18 and 65. As of May 25, 2022, more than 291,000 Oklahomans received health care through this program. Medicaid expansion is funded 90% from federal money. With this increased investment of new money to the state, Oklahoma could have provided a stabilizing factor for our rural communities not just in improved health care but in bringing home our federal dollars as a boost to our economy. The administrative costs for the state to operate this program run between 3% and 4%. General Medicaid administrative costs are met with 50% federal and 50% state funding, but there are 20 Medicaid Administrative matching formulas.
Immediately after the approval of Medicaid expansion, Gov. Kevin Stitt set out to privatize its administration. He contracted with three companies to operate the program, which included allowing 15% for administrative costs and required the programs to be operated under managed care criteria. Medicaid managed care provides for the delivery of Medicaid health benefits and additional services through contracted arrangements between state Medicaid agencies and managed care organizations (MCOs) that accept a set per member per month (capitation) payment for these services. The least costly medical care they provide, the more profit they reap. These contracts fell through as the court ruled that they were not processed properly. That did not dissuade our leaders. The governor and the Legislature passed a bill to require contracted managed care to be available starting in 2023. While I do not believe that managed care is the best means of health care payment, the state could run a managed care-like program without regard to profit.
The provision of quality health care is dependent on the availability of well-trained health care providers. Many people prefer living in rural Oklahoma. We need to surround them with the services needed to let them prosper in place. Quality public education is the foundation of our democracy, but it is also the bedrock of a thriving economy. We must provide quality public education from birth through career attainment that pays a living wage, including farmers, welders, nurses, doctors and others. We do that by identifying the potential of each student and nourishing them through the entire education process allowing them to work where they want to live.
Finally, we need to work outside of our silos. The Indian Health Service is an important health care service in our rural counties. The state needs to coordinate and cooperate with those services. We also need to undergird our public health and mental health care systems. And we need to ensure that all Oklahomans can smoothly receive triage services with specialty care only available in more densely populated areas.
The result of addressing all these issues, if done right, will gain the by-product of markedly reducing poverty in Oklahoma.
Marilynn Knott is a retired Oklahoma State Department of Human Services administrator of planning, policy and research, and now serves on the Oklahoma Poor People’s Campaign Policy team.
