LAWTON – A physician who administered a man-age-care vision program in Lawton for several years is mystified why the State of Oklahoma would outsource its Medicaid program to out-of-state companies.
“I’m having trouble understanding how the state can save money by sending its Medicaid dollars out-of-state,” said Dr. Richard Swales, a Lawton optometrist.
“In terms of quality, there’s no reason to hire other vendors to manage Oklahoma’s Medicaid program,” he said. The Oklahoma Health Care Authority “is doing the job quite well.”
The OHCA’s cost of administering Oklahoma’s Medicaid program is about 5%, leaving 95% of the funds for Medicaid recipients, Swales said. “So why hire four out-of-state companies and pay them 15% in administrative fees?”
Furthermore, he noted, the OHCA is “providing these services through jobs that are in our state.”
The OHCA is “doing a magnificent job” in its administration of Oklahoma’s Medicaid program, Swales said.
Almost 959,000 low-income Oklahomans were enrolled in SoonerCare, the state’s Medicaid program, as of March 16. Of those, 65% are individuals under the age of 21 and 35% are adults, ac- cording to the OHCA.
Swales is the president of Primary Vision Care Services. PVCS is an Oklahoma corporation that provides a vision care benefits plan called “VisionAdvantage” in this and other nearby states. It is a stand-alone or enhancement vision care plan that offers unlimited eye care services and wholesale vision eyewear.
Its VisionAdvantage Plan uses a network of selected independent optometrists throughout Oklahoma, Texas, Arkansas, Kansas and Missouri.
In the mid-1990s to about 2003 “we provided a Medicaid managed-care vision program for Comanche County Memorial Hospital,” Swales said. “We did that for about seven years” and it was “well-received.”
Humana, Centene, UnitedHealthcare and BlueCross BlueShield of Oklahoma have been chosen to provide “managed care” of Oklahoma’s Medicaid program, beginning Oct. 1.
Managed care is a system of health care in which patients agree to visit only certain doctors and hospitals, and in which the cost of treatment is monitored by a managing company.
Although the contracts with the four healthcare giants involve more than $2 billion annually in state funds, the Legislature was bypassed in the decision-making process.
Humana, Centene, and UnitedHealthcare – three of the four companies selected to manage Oklahoma’s Medicaid program – “face serious allegations of misconduct,” said Dr. Woody Jenkins, a Stillwater-based physician and co-chair of the Oklahoma State Medical Association Rural Physician Section.
Although state lawmakers were bypassed in the selection process, “that doesn’t mean the Legislature can’t stop this disaster before it happens,” Jenkins said.
Senate Bill 131, sponsored in the House of Representatives by Rep. Marcus McEntire, R-Duncan, and co-authored by Rep. Daniel Pae, R-Lawton, would require the OHCA to develop a program that controls costs for the state while improving health outcomes for Medicaid recipients.
SB 131 “seeks to achieve the same goals” as the Governor’s outsourcing plan “but without the harm to Medicaid recipients that outsourcing undoubtedly would cause,” said Jay Johnson, president of Duncan Regional Hospital and board chairman of the Oklahoma Hospital Association.
The House passed the measure, 73-17, on April 20, and returned it to the Senate the next day for consideration of House amendments.