Medicaid Cuts: What do they mean for Oklahomans?

Medicaid cuts are on the table in Washington within the 'Big, Beautiful Bill'. This week, Scott Mitchell breaks down the impact and ramifications of the proposed legislative cuts in this weeks Hot Seat. Follow along for the key takeaways or watch our full roundtable at the top of this page.

Introduction and Context

1. The discussion centers on proposed Medicaid cuts in Oklahoma and their potential impact, featuring guests Wanda Felty (Center for Learning and Leadership) and RoseAnne Duplan (Disability Law Center).
2. Recent Senate developments have removed some Medicaid cuts from the current bill, but concerns remain about future threats to funding and services.

Medicaid Cuts and Their Implications

1. The original bill targeted a Medicaid provider fee (called a tax in federal terms, a fee in Oklahoma) that supports rural healthcare access. Its removal or reduction would have directly impacted vulnerable populations.
2. Any reduction in the federal Medicaid match to Oklahoma would most affect the state's most vulnerable residents, including people with disabilities and the elderly.

Historical Precedents and Optional Services

1. When Oklahoma previously faced Medicaid budget deficits (e.g., in 2017), the first cuts were to optional services, especially in-home supports for seniors and people with disabilities. Notices of service termination were sent, though funding was later found to avoid cuts.
2. Optional services, such as in-home and community supports, are at higher risk during budget shortfalls because they are not federally mandated. Loss of these services forces individuals into more expensive institutional care.

Medicaid Expansion and Coverage

1. Oklahoma expanded Medicaid to cover more low-income adults, which has improved access to healthcare for many who previously had none after aging out of children's Medicaid.
2. The state constitutionally guarantees coverage for low-income adults and children, but optional supports for people with disabilities and seniors remain vulnerable to cuts.

Consequences of Cutting Optional Supports

1. Eliminating in-home and community-based supports would likely result in increased institutionalization, which is significantly more expensive for the state (up to three or four times the cost of in-home care).
2. Oklahoma previously closed state-run institutions due to inefficiency and poor outcomes, but cuts could force the state to rebuild such facilities at great expense.

Provider Rates and Rural Hospitals

1. Reducing provider reimbursement rates is a common cost-saving measure but leads to fewer providers accepting Medicaid and can result in rural hospital closures.
2. There is ongoing concern about the stability of rural healthcare infrastructure if Medicaid cuts proceed.

Impact on Families and Individuals

1. Over 7,000 Oklahomans with disabilities and 25,000 aging individuals rely on Medicaid waivers and in-home supports. Losing these services would force many into institutions and create severe hardships for families.
2. Many families have only recently received these services after waiting years, and now risk losing them again.

Work Requirements and Administrative Burdens

1. Proposed work requirements for Medicaid would require recipients to work a minimum number of hours and frequently recertify eligibility. Most able recipients are already working, but administrative hurdles could cause many to lose coverage.
2. These requirements disproportionately impact people with disabilities who may be working part-time or struggle with paperwork, risking loss of necessary medical coverage.

Advocacy and Urgency

1. The legislative process is moving quickly, potentially leaving little time for public input or advocacy before decisions are finalized.
2. Both guests, as mothers of adults with severe disabilities, stress the personal and statewide impact of these policy changes and urge lawmakers to protect community-based supports for vulnerable populations.

Closing Message to Lawmakers

1. The guests urge Senator Lankford and other lawmakers to ensure long-term, community-based supports are protected and adequately funded, warning that otherwise, the only option for the state will be to cut optional benefits, harming the most vulnerable Oklahomans