§56-1010.1. Short title - Oklahoma Medicaid Program Reform Act of

1,335 words·~6 min read·/ok/title-56-poor-persons/56-1010-1

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

2003 – Purpose - Coverage – Waivers - Health Employee and Economy Improvement Act (HEEIA) Revolving Fund.

A. Section 1010.1 et seq. of this title shall be known and may be cited as the “Oklahoma Medicaid Program Reform Act of 2003”.

B. Recognizing that many Oklahomans do not have health care benefits or health care coverage, that many small businesses cannot afford to provide health care benefits to their employees, and that, under federal law, barriers exist to providing Medicaid benefits to the uninsured, the Legislature hereby establishes provisions to lower the number of uninsured, assist businesses in their ability to afford health care benefits and coverage for their employees, and eliminate barriers to providing health coverage to eligible enrollees under federal law.

C. Unless otherwise provided by law, the Oklahoma Health Care Authority shall provide coverage under the state Medicaid program to children under the age of eighteen

(18)years whose family incomes do not exceed one hundred eighty-five percent (185%) of the federal poverty level.

D. 1. The Authority is directed to apply for a waiver or waivers to the Centers for Medicare and Medicaid Services

(CMS)that will accomplish the purposes outlined in subsection B of this section. The Authority is further directed to negotiate with CMS to include in the waiver authority provisions to:

a. increase access to health care for Oklahomans,

b. reform the Oklahoma Medicaid Program to promote

personal responsibility for health care services and

appropriate utilization of health care benefits

through the use of public-private cost sharing,

c. enable small employers, and/or employed, uninsured

adults with or without children to purchase employer-

sponsored, state-approved private, or state-sponsored

health care coverage through a state premium

assistance payment plan. If by January 1, 2012, the

Oklahoma Employer/Employee Partnership for Insurance

Coverage premium assistance program is not consuming

more than seventy-five percent (75%) of its dedicated

source of funding, then the program will be expanded

to include parents of children eligible for Medicaid,

and

develop flexible health care benefit packages based

upon patient need and cost.

2. The Authority may phase in any waiver or waivers it receives based upon available funding.

3. The Authority is authorized to develop and implement a premium assistance plan to assist small businesses and/or their eligible employees to purchase employer-sponsored insurance or “buy- in” to a state-sponsored benefit plan.

4. a. The Authority is authorized to seek from the Centers

for Medicare and Medicaid Services any waivers or

amendments to existing waivers necessary to accomplish

an expansion of the premium assistance program to:

(1)include for-profit employers with two hundred

fifty employees or less up to any level supported

by existing funding resources, and

(2)include not-for-profit employers with five

hundred employees or less up to any level

supported by existing funding resources.

b. Foster parents employed by employers with greater than

two hundred fifty employees shall be exempt from the

qualifying employer requirement provided for in this

paragraph and shall be eligible to qualify for the

premium assistance program provided for in this

section if supported by existing funding.

E. For purposes of this paragraph, “for-profit employer” shall mean an entity which is not exempt from taxation pursuant to the provisions of Section 501(c)(3) of the Internal Revenue Code and “not-for-profit employer” shall mean an entity which is exempt from taxation pursuant to the provisions of Section 501(c)(3) of the Internal Revenue Code.

F. The Authority is authorized to seek from the Centers for Medicare and Medicaid Services any waivers or amendments to existing waivers necessary to accomplish an extension of the premium assistance program to include qualified employees whose family income does not exceed two hundred fifty percent (250%) of the federal poverty level, subject to the limit of federal financial participation.

G. The Authority is authorized to create as part of the premium assistance program an option to purchase a high-deductible health insurance plan that is compatible with a health savings account.

H. 1. There is hereby created in the State Treasury a revolving fund to be designated the “Health Employee and Economy Improvement Act (HEEIA) Revolving Fund”.

2. The fund shall be a continuing fund, not subject to fiscal year limitations, and shall consist of:

a. all monies received by the Authority pursuant to this

section and otherwise specified or authorized by law,

monies received by the Authority due to federal

financial participation pursuant to Title XIX of the

Social Security Act, and

c. interest attributable to investment of money in the

fund.

3. All monies accruing to the credit of the fund are hereby appropriated and shall be budgeted and expended by the Authority to implement a premium assistance plan and to fund the state share for the Oklahoma Medicaid Program on or after July 1, 2020, unless otherwise provided by law.

I. 1. The Authority shall establish a procedure for verifying an applicant’s individual income by utilizing available Oklahoma Tax Commission records, new hire report data collected by the Oklahoma Employment Security Commission, and child support payment data collected by the Department of Human Services in accordance with federal and state law.

2. The Oklahoma Tax Commission, Oklahoma Employment Security Commission, and Department of Human Services shall cooperate in accordance with federal and state law with the Authority to establish procedures for the secure electronic transmission of an applicant’s individual income data to the Authority.

3. The Department of Public Safety shall cooperate in accordance with federal and state law with the Authority to establish procedures for the secure electronic transmission of an applicant’s individual identification data to the Authority.

J. An employer participating in the premium assistance program created under this section as of May 1, 2024, may utilize a self- funded or self-insured health care plan as a participating health care plan if:

1. The self-funded or self-insured health care plan is recognized by the Insurance Department under Section 6012 of Title 36 of the Oklahoma Statutes;

2. The self-funded or self-insured health care plan covers all essential health benefits as required by the Authority and all other health benefits required under applicable federal laws;

3. The self-funded or self-insured health care plan otherwise complies with all applicable federal laws including but not limited to the Employee Retirement Income Security Act of 1974 (ERISA);

4. The self-funded or self-insured health care plan assesses a monthly premium on members and maintains a rate schedule for provider reimbursement;

5. The self-funded or self-insured health care plan meets actuarial standards for the premium assistance program as determined by the Authority and the employer submits an attestation to the Insurance Department that the self-funded or self-insured health care plan meets such actuarial standards; and

6. The Authority receives the necessary federal approval for self-funded or self-insured health care plans to participate in the premium assistance program. Added by Laws 1993, c. 336, § 1, eff. July 1, 1993. Amended by Laws 1997, c. 421, § 1; Laws 1999, c. 288, § 1, eff. Sept. 1, 1999; Laws 1999, c. 323, § 1, emerg. eff. June 8, 1999; Laws 2000, c. 251, § 3, eff. July 1, 2000; Laws 2003, c. 464, § 1, eff. July 1, 2003; Laws 2004, c. 136, § 1, eff. July 1, 2004; Laws 2006, c. 315, § 15, emerg. eff.

June 9, 2006; Laws 2007, c. 230, § 1, eff. Nov. 1, 2007; Laws 2008, c. 3, § 27, emerg. eff. Feb. 28, 2008; Laws 2008, c. 158, § 1, eff. Nov. 1, 2008; Laws 2008, c. 412, § 1, eff. Nov. 1, 2008; Laws 2009, c. 128, § 5, eff. Nov. 1, 2009; Laws 2010, c. 309, § 3, eff. Nov. 1, 2010; Laws 2017, c. 136, § 1, eff. Nov. 1, 2017; Laws 2020, c. 19, § 1, eff. July 1, 2020; Laws 2022, c. 309, § 2, eff. Nov. 1, 2022; Laws 2024, c. 133, § 2, eff. July 1, 2024. NOTE: Laws 2007, c. 318, § 3 repealed by Laws 2008, c. 3, § 28, emerg. eff.

Feb. 28, 2008.