June 14, 2023 – Medicaid in Oklahoma just got a significant upgrade as the Oklahoma Health Care Authority recently announced that it has awarded managed care contracts to three managed care organizations. This move marks an essential step towards reshaping the healthcare landscape in the state, which has consistently ranked as one of the worst states in the nation for health outcomes.

The chosen organizations are Aetna Better Health of Oklahoma, Humana Healthy Horizons of Oklahoma and Oklahoma Complete Health, a subsidiary of the Centene Corp. These MCOs will be tasked with managing the healthcare of about 800,000 Oklahomans that receive Medicaid through SoonerCare. 

“With these partnerships and this shift to SoonerSelect, we can change the course of health care in Oklahoma,” said Health Care Authority CEO Kevin Corbett. “I hope everybody believes that. We certainly do.”

Managed care is a healthcare delivery system that’s designed to manage cost, utilization, and quality. It’s about ensuring that patients get the care they need, without unnecessary expenses or services. This can lead to more cost-effective healthcare and, ideally, better health outcomes for patients. The goal is to provide better coordinated care and preventative services to improve overall health outcomes and reduce emergency room visits and hospital admissions. 

The contracts are expected to cost the state approximately $3.75 billion over the first 15 months. This makes them some of the largest contracts in state history. MCOs will be paid a flat fee for every Medicaid beneficiary that they provide services to, which is a change from the current fee-for-service (FFS) model adopted in the state. 

This is a big move for the Stitt administration, which has been trying to shift Oklahoma’s Medicaid program to the managed care model to reduce costs. However, some are expressing opposition to the change. The state previously attempted to implement managed care and it was deemed a failure. Patient advocates also argue that MCOs are incentivized to cut costs, which could be detrimental to patient care. 

The managed care model is implemented in at least 40 other states in some form. Under the model, Medicaid recipients will get to choose their own plan, which at least provides them some choices. It will be interesting to see how managed care fares this time around in Oklahoma. 

The contracts will last until at least June 30, 2025 and include renewal options should the parties both agree to extend.