OHCA, which administers the state’s Medicaid program, is set to consider an emergency rule change during a special board meeting on Tuesday that would end benefits if letters sent to enrollees are returned as undeliverable.
OHCA proposed a similar rule late last year that was met with controversy, as critics argued it would leave vulnerable Oklahomans, such as children and those experiencing homelessness, without health coverage. That rule was set for consideration before the board earlier this year, but the vote was put on hold pending conversations with the federal Centers for Medicare & Medicaid Services.
There are few changes in the new proposal’s language compared to the one OHCA previously suggested. However, the new rule no longer references the measure known as the Act to Restore Hope, Opportunity and Prosperity for Everyone, or the HOPE Act. That measure was passed by the Legislature during the 2018 session. It aims to increase the state’s Medicaid eligibility verification process by using private vendors to perform eligibility checks. Under the law, payments to vendors would be based on the amount of money saved.
“The HOPE Act requires verification of a member’s residency status,” OHCA’s first proposal read. “In accordance with the new policy, a member’s eligibility will be terminated if his or her mail is returned to the agency as unforwardable, with address unknown.”
Instead, the agency is now relying on federal regulations and CMS guidance that allow states to check Medicaid eligibility by sending letters to an enrollee’s residence, said OHCA spokeswoman Jo Stainsby. The agency will use letters to determine residency.
“Yes, we received policy guidance from CMS and this rule does follow that guidance,” Stainsby said. “Eligibility criteria — because one of the criteria for being eligible for SoonerCare is Oklahoma residency — and returned mail indicates change to residency or that a member could possibly be deceased.
“So therefore, it’s one of the ways the federal government wants states to pursue verification.”
However, Stainsby said, she did not know whether states are required to use mail delivery to determine eligibility.
“I don’t know if it’s a written rule, but CMS did tell us, ‘This is what you should be doing,'” she said.
Stainsby said the agency would not immediately cancel an enrollee’s benefits after receiving back one undeliverable letter. The agency will send a second letter announcing the loss of benefits, email the Medicaid patient if they have an address on file and post an alert to their online SoonerCare account.
“We are going to be proactive,” she said.
The proposed rule states the agency will make a “reasonable” attempt to verify the patient’s address.
“In accordance with the new policy, a member’s eligibility will be terminated if his or her mail is returned to the agency as unforwardable, with address unknown, and the Oklahoma Health Care Authority has made a reasonable, but unsuccessful attempt to verify the member’s current address,” the new proposed rule reads in part.
Advance notice is not required to be given to members when eligibility is terminated due to returned mail, the proposed rule states. If an enrollee’s benefits are terminated and the agency learns of their new location during the eligibility period, their benefits will be reinstated.
If a patient loses their eligibility, they must reapply to the SoonerCare program.
The proposal states: “Savings are expected to be realized as members that have not provided a current address lose eligibility.”
The proposal says other states, such as Alabama, Colorado and Ohio, also use returned mail to terminate eligibility.
However, Colorado’s Medicaid verification plan, approved and maintained by CMS, does not explicitly mention sending letters to verify eligibility. Ohio’s plan doesn’t directly mention letter verification and accepts spoken verification from the enrollee. If the agency receives conflicting information, it might request more documentation.
Oklahoma’s Medicaid verification plan states “Postal returned mail indicators may also trigger a request for updated information from the member.”
Medicaid uses state and federal money to offer health coverage, and uses a fee-for-service system to reimburse providers for procedures.
The public comment period for the initial proposal ended on Dec. 27, 2018. Stainsby said. There will not be another one for the amended proposal.
If the board approves the proposal, it will go to Gov. Kevin Stitt’s office for final approval.
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