Medicaid enrollment in Oklahoma reached new highs in May and June, driven by widespread job losses and federal action meant to prevent states from dropping people from the health coverage.
“The cause is mostly due to COVID measures taken to ensure members maintain coverage,” said a spokeswoman for the Oklahoma Health Care Authority.
“For June, we saw an unusually large amount of new members compared to average for previous months.”
Enrollment in SoonerCare, the state’s Medicaid program, jumped to 865,851 in June. That was up by more than 32,500 from May, which was up about 11,500 from April.
Enrollment in March, when the state logged its first case of COVID-19, was just under 808,000.
Carly Putnam, policy director and health care policy analyst for the Oklahoma Policy Institute, said, “From a public health perspective, we can see that Medicaid is doing what it is supposed to do. It is supposed to exist for when people don’t realistically have other options. And that is exactly what is happening right now.
“We also know that there are many, many more people who are not getting that coverage and do not have options and are coasting on hope, and hope is a terrible public health strategy.”
Putnam was referring to the fact that many jobless people in Oklahoma don’t qualify for Medicaid and can’t purchase coverage on the Affordable Care Act exchange.
That will change after the state government implements the Medicaid expansion approved on June 30, but that could take as long as a year.
When the pandemic began, Oklahoma already had the second-highest rate in the nation of uninsured people. A study by the Robert Wood Johnson Foundation and the Urban Institute estimated that 213,000 people in the state could lose employer-sponsored health insurance if the unemployment rate hit 15% during the pandemic.
Oklahoma’s unemployment reached 14% in April and was 12.6% in May.
The employment picture in Oklahoma has improved dramatically in the past few weeks, though nearly 120,000 Oklahomans received unemployment assistance during the second week of July, and 8,579 people filed initial claims for assistance, according to the U.S. Labor Department.
“We definitely got an increase due to the unemployment rate,” Melissa Richey, chief of communications for the Oklahoma Health Care Authority, said of the rise in Medicaid enrollment.
Meanwhile, the most recent results of a weekly survey by the U.S. Census Bureau showed other aspects of economic pain in Oklahoma. More than 27% of Oklahomans surveyed reported insecurity about making housing payments; that was up from 23% the week before. Forty percent reported a loss of income and 30% reported an expected loss in income. The responses were collected from July 9 through July 14.
Federal funding boost
Because of action taken to help states deal with the pandemic, the federal share of the Medicaid program — the federal medical assistance percentage (FMAP) — was increased by 6.2 percentage points.
Oklahoma “went from getting $1.94 for every dollar the state spends to getting $2.60 from the feds for every dollar the state spends,” Putnam said.
A condition for taking the money was that states suspend recertification of participants whose income might have otherwise been disqualifying.
“So on the one hand the state is seeing really, really high Medicaid enrollment at the moment but that’s I think in large part because the state has not been able to remove people from coverage,” Putnam said.
“Which is important, because with everything happening right now we need to prioritize people getting the health care that they need. And this is absolutely the wrong time to be determining if a person is making an extra 50 cents an hour and therefore needs to be cut off Medicaid coverage.”
Adults without children who lose their jobs, though, could be left without options. People with no income are not eligible for federal subsidies through the health care exchange. The Affordable Care Act was designed for those people to receive Medicaid. However, Oklahoma lawmakers and governors chose for several years not to expand Medicaid; expansion was added to the state constitution last month by a statewide vote.
Putnam said she was worried about uninsured people who couldn’t afford to see their doctors about chronic conditions; who couldn’t afford to get tested for COVID-19; and who might be bankrupted from costs associated with COVID-19.
Even some of those who have coverage through Medicaid are delaying medical care, an issue that is also common among people with private insurance.
Despite the increase in enrollment, SoonerCare expenditures at the Oklahoma Health Care Authority in May and June were below the same months of 2019.
“People are still concerned with going to the doctor, with booking their elective surgery, so you’re going to see that difference in numbers because of that,” Richey said.
“We are prepared for when they do start feeling comfortable going back to the doctor or scheduling their surgery so that surplus we are starting to build up, we will be able to carry over into our fiscal year 2021.”