Oklahoma Medicaid Beneficiaries, Beneficiary Advocates Sue State Medicaid Agency

Some Oklahoma Medicaid managed care beneficiaries, the Oklahoma chapter of the American Academy of Pediatricians and the Community Action Project of Tulsa County have filed a class-action lawsuit against the Oklahoma Health Care Authority, charging that the agency violated federal law by using a reimbursement scale that does not meet the market rate, resulting in "pediatricians limiting or refusing to accept Medicaid patients," Tulsa World reports. The lawsuit also alleges that the agency, which oversees Medicaid, "failed" to create and implement a coordinated system of care, did not "adequately" tell families of their children's "rights" to medical services and "deprived" children of "timely and continuous health care." Last year, the state Legislature provided OHCA with an 18% budget increase, allowing the agency to adjust Medicaid reimbursement rates for the first time since 1992. Steven Dow, executive director of the Community Action Project, said, "Unfortunately, that legislation has barely made a dent in the problem. Reimbursement rates were adjusted in an uneven fashion, with rates for some specialist and preventive primary care services actually decreasing. Meanwhile, the rate increases failed to address the systematic and long-standing problems with the [program's] administration."

OHCA's Say
Mike Fogarty, OHCA's CEO, countered the allegations, saying, "Frankly, I am surprised and disappointed that apparently some pediatricians are planning to file this lawsuit ... when less than a year ago the Legislature and the governor supported and passed the largest financial increase in the history of the Medicaid program." In July, OHCA sent providers a letter saying that the readjusted rates did not affect all procedures; some procedures would be reimbursed at a "significantly" higher fee and others would remain the same or decrease. According to Fogarty, the program has raised screening and immunization rates and has increased Medicaid enrollment by 39%, an achievement that won recognition from the Kaiser Commission on Medicaid and the Uninsured. Fogarty added, "We all should be more concerned with maintaining available quality health care for Oklahoma Medicaid recipients than dealing with potential lawsuits alleging some doctors are not being paid enough to see low-income kids. Obviously, they have chosen to attack Oklahoma's nationally recognized Medicaid program instead of working with us" (Graham, Tulsa World, 3/19).