WHAT 1.State and federally funded health care coverage 2.Federal authority is under titles XIX and XXI of Social Security Act. State authority exists in titles 56 and 63 of OAC. 3. State legislature has to actively approve OHCA permanent agency rules. 4. Further, in order to receive federal financial participation, authority has to exist in 1 of 2 documents: waiver or state plan.
WHEN Providers 1.Process claims in seconds and pay over 900,000 claims every Wednesday. 2.Provider portal allows providers to make changes and submit documentation or claims in an automated environment. Members 1.Pregnant women, parents and children are eligible to apply 24/7 on mysoonercare.org, the nation’s first real-time, automated online enrollment system.
WHY 1.Created in 1965 with the specific purpose of health coverage of those without direct access to traditional source of insurance (AFDC) to be paired with Medicare (aged) 2.Now provides critical health protection for key vulnerable/high risk populations 1.Low-income families with children and people with disabilities 2.Long-term care for older Oklahomans and people with disabilities 3.Supplemental coverage for low-income Medicare beneficiaries 3.Supports state’s health infrastructure 4.Different optional expansions over the years 1.1997- expanded coverage to pregnant women and some kids 2.2005- Insure Oklahoma was created to offer subsidies for small businesses and their employees
HOW SoonerCare Choice, Oklahoma’s own Patient Centered Medical Home program, seeks to transform delivery of health care through: 1.Interdisciplinary team approach to care coordination 2.Standardization of care in accordance with evidence- based guidelines 3.Tracking test and consultations and follow-up after ER/hospitalizations 4.Active measurement of quality and adoption Quality Improvement strategies
INSURE OKLAHOMA Who Qualifies? Insure Oklahoma's Employer Sponsored Insurance plan helps employers provide their eligible employees with affordable health care. Eligible individuals may also participate in the Insure Oklahoma Individual Plan to have affordable health care. Insure Oklahoma provides affordable health care for low- income working families in Oklahoma through premium assistance.
INSURE OKLAHOMA The Insure Oklahoma program is funded by federal and state dollars. Insure Oklahoma’s state share is 100 percent tobacco tax. Current waiver period ends in 2015. OHCA and state leadership are working with federal partners for a long-term extension.
CONTACT AND RESOURCES Carter Kimble Director of Government Relations 405.522.7510 Carter.Kimble@okhca.org www.okhca.org www.insureoklahoma.org