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SoonerCare Plus - Discontinued - Oklahoma

NOTE: The SoonerCare Plus Program ended January 1, 2004.

During a special board meeting on Nov. 7, 2003, the Oklahoma Health Care Authority (OHCA) Board approved the proposal to discontinue the SoonerCare Plus program effective Jan. 1, 2004. This decision will cause the following changes for SoonerCare Plus members:

·         The SoonerCare Plus members who remain eligible will continue to receive care through their Health Maintenance Organizations (HMO) through Dec. 31, 2003.

·         New Medicaid beneficiaries who are eligible for managed care in the SoonerCare Plus service areas will not be enrolled in an HMO for December. The annual SoonerCare Plus Open Enrollment period is cancelled.

·         Beginning Jan. 1, OHCA will transfer approximately 189,000 SoonerCare Plus members into a temporary but enhanced fee-for-service system. The white OHCA ID card will be used to access services.

·         During the transition, a Primary Care Provider (PCP) will no longer be necessary to manage beneficiary’s health care. However, the beneficiary may continue to see the current PCP, if he or she has a fee-for-service contract with Oklahoma Medicaid and if he or she is willing to see the beneficiary.

·         On or before April 1, the agency will transition members into the SoonerCare Choice program, which will be expanded from its current operations in 61 counties to a statewide managed care system.

·         No Medicaid beneficiary will lose eligibility due to the transition.

·         Oklahoma Department of Human Services will continue to accept applications and determine eligibility;

·         Beneficiaries in SoonerCare Choice, nursing facilities and waiver programs, such as the Advantage waiver, will be not be affected by this transition.

·         Letters and notifications will be mailed to beneficiaries detailing the transition.

Important phone numbers during transition:

·         Prescriptions - call Medicaid Pharmacy Help Desk at 405-271-6349 or at 1-800-831-8921 toll free.

·         Benefits or billing questions; ID cards - call SoonerCare Helpline at 1-800-987-7767 toll free.

·         Prior authorizations - call Medical Authorizations at 405-522-7555 or Customer Service 1-800-522-0310 toll free.

·         Locating a physician or a specialist - call Medicaid Care Management at 405-522-7171 or Customer Service 1-800-522-0310 toll free.

·         Health questions - call SoonerCare Nurse Advice Line at 1-800-530-3002 toll free.

·         Transportation - call SoonerRide at 1-877-404-4500 toll free.

For more information call Customer Service at 405-522-7171, or 1-800-522-0310 toll-free.

The following information about the discontinuation of the SoonerCare Plus Program is from a press release issued November 12, 2003 by the Oklahoma Health Care Authority (OHCA).

OHCA Opts Not to Renew HMO Contracts

Oklahoma City – News of increased health care costs and a decision by a health maintenance organization (HMO) to pull out of the state Medicaid program prompted the Oklahoma Health Care Authority board to approve a proposal to end its health maintenance organization (HMO) contracts and switch to the state’s other managed care system, SoonerCare Choice.

This action came after Unicare Health Plan of Oklahoma notified the Oklahoma Health Care Authority that they do not intend to renew their managed care contract serving areas of Oklahoma City, Tulsa and Lawton. The contract expires on Dec. 31.

On Jan. 1, the agency will transfer approximately 189,000 people into a temporary but enhanced fee-for-service system. This means a person will be eligible for care from any willing contracted provider and the state would then pay the provider on a per service basis. It would be enhanced by having agency staff available to help patients find care if needed. On or before April 1, the agency will transition members into SoonerCare Choice.

Currently operating in 61 counties, SoonerCare Choice features similar benefits as the current HMO managed care system called SoonerCare Plus; however, it makes payments directly to physicians and other providers for care rather than through an HMO system. It is a program in which the OHCA contracts directly with providers throughout the state to provide primary health care services and to manage the health needs of their patients. Currently, OHCA provides services for 160,000 people through the SoonerCare Choice program.

Under SoonerCare Plus, the Oklahoma Health Care Authority contracted with three health maintenance organizations (HMOs) to provide medically necessary services to patients living in 16 counties in the urban areas of Oklahoma City, Tulsa and Lawton. OHCA budgeted $222.4 million for the HMO-based program for a six-month period beginning Jan. 1, 2004. Federally-mandated actuarial developed rates determined the health plan premiums should be increased to $233.3 million, leaving a difference of about $10.9 million. OHCA made the health plans an offer based on the available budgeted amount.

These changes do not affect those Medicaid patients living in nursing homes or those people served in the Home and Community Based Waivers such as the Advantage program. Letters and notifications will be mailed to affected beneficiaries in the coming weeks detailing the transitional information and the resources that will be available.

Source

http://www.ohca.state.ok.us/general/media/newpress/pr111203.htm

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