Medicaid was created to subsidize medical care for the most vulnerable Americans. In order to do that, it’s important to weed out fraud and abuse.
A little over six months ago, Governor Mary Fallin signed into law the Act to Restore Hope, Opportunity, and Prosperity for Everyone (the HOPE Act). It updates the Oklahoma Health Care Authority’s (OHCA) process of verifying the eligibility of enrollees for Oklahoma’s Medicaid program, known as SoonerCare.
The HOPE Act requires OHCA to verify on a quarterly basis participant’s earned and unearned income, employment status, residency status, immigration status, financial resources, and enrollment status in other state-administered assistance programs, as well as their participation in out-of-state public assistance programs. OHCA is also required to cross-reference Medicaid recipients with new death records, incarceration reports, and lottery winnings to prevent improper subsidies or purposeful fraud.
There were approximately 794,000 Oklahomans enrolled in SoonerCare as of July 2018. The law requires OHCA to utilize private contractors to aid the agency with the process of validating Medicaid recipient’s eligibility information and ensuring accuracy. The law dictates that the cost savings from bringing in outside vendors must be greater than annualized costs to the state for this service.
On July 11, OHCA began to search for capable private contractors by releasing a public Request for Information (RFI); responses to state government were due on August 17. A Request for Proposal should soon follow to complete the process of selecting contractors.
In addition to comprehensive quarterly eligibility reviews, OHCA will require new SoonerCare applicants to complete a new identity authentication process consisting of a series of financial and personal questions. According to the law, OHCA must report any suspected cases of fraud or identity theft to the state Attorney General’s office.
To gauge the impact of the law, OHCA will be required annually to publish a metric report detailing how many Medicaid cases were reviewed and closed, the number of cases referred to the state Attorney General’s office, and the cost savings that resulted from the full implementation of the HOPE Act.
If experience from Illinois, Pennsylvania, Arkansas, Minnesota, and other states is any guide, the cost savings will be significant once the program is fully implemented.