SoonerCare recipients to get new rules

Optometrist Sahab Astani, left, performs an eye exam on Ryann Barnes in the W.W. Hastings Hospital in Tahlequah, where many patients who receive insurance from SoonerCare visit.

TAHLEQUAH, Okla. — Oklahomans with SoonerCare will need to make sure their home addresses are up-to-date if they want to keep their health insurance, as the state's Health Care Authority is implementing a new rule to stay in compliance with federal regulations.

Under the new rule, which was approved by the agency's board in May and signed by Gov. Kevin Stitt in June, the OHCA will discontinue SoonerCare members' eligibility for coverage if they cannot verify the member's current address. However, they have time to make sure their information is current, according to Jo Stainsby, OHCA office of public information director.

"We're starting now with trying to make sure people are aware to give them plenty of time," said Stainsby. "Our board was real concerned to make sure that we were doing everything that we could to get a hold of members, because the objective is not to reduce the rolls or make anybody lose eligibility. The objective is to make sure our information is right, they're on the rolls as they should be, and they're getting services."

The OHCA will start a calling campaign toward the end of the month to reach out to members who are flagged as having invalid addresses or whose mail has been returned to the OHCA. Phone calls will be made at different times of the day - evenings and weekends - for those who are busy during the day.

Stainsby said it's a preemptive initiative to remind SoonerCare members while the OHCA updates its computer system.

"And then this fall, probably September or October, we'll take all the return mail flags off the system and start fresh," she said. "Then, once we start getting returned mail back from our regular mailouts to our members, when it comes back to us as returned, we'll try again to reach out to them, and if we can't, eventually they will be taken off of the rolls."

Should the OHCA not be able to verify a member's current residency, it will send out a 30-day notice of discontinued eligibility by mail and email, if the agency has an email address on file. Stainsby said there won't be "any action for removal until late in the year at best, so they do have time," but the OHCA also encourages recipients to call and make sure their information is accurate.

The OHCA will also conduct outreach to some of its SoonerCare providers.

"We're going to be letting them know, because if a member comes in and they've lost eligibility or we need to get a hold of them, they can see a flag and tell the member, 'Hey, you need to call in,' and that's all they have to do," Stainsby said.

While the OHCA has asserted it will try to prevent people from slipping through the cracks, some are concerned that lower-income Oklahomans might lose their coverage - especially if they are homeless. Oklahoma Institute for Child Advocacy CEO Joe Dorman said in a OICA column that while the intent of the rule is to prevent fraud, many SoonerCare residents rely on program because they live in unstable conditions.

"Some move between the homes of friends and relatives; some are fleeing abusive relationships; others have recently lost jobs and have moved to look for work," Dorman said. "Of course, many of these people have one or more children, who are also eligible for SoonerCare. These families are likely to be hard to find and are therefore the most at risk of losing their coverage."

While he voiced concerns, Dorman also wrote that he's happy the OHCA has been making an effort to contact each client. He was selected to be on a task force with OHCA board members and staff, which was formed to ensure SoonerCare members' information is valid and to find ways to communicate the new federal requirement.

"This is a good example of level heads working through a problem and finding better solutions to address the situation," said Dorman.

Meanwhile, the new rule has a chance of impacting local providers. Cherokee Nation is already planning on training staffers so they can address the situation properly.

"The Cherokee Nation is awaiting training, and there are webinars scheduled by the state in the next couple of weeks for our staff on this issue," said Connie Dunavin, special projects officer for Health Administration Services. "We do encourage our tribal citizens enrolled in SoonerCare or Medicaid who might have changed their mailing address to call our Cherokee Nation SoonerCare hotline at 1-844-749-GAME or see a patient benefits coordinator at one of our health centers, and we can update their address with the state in real time."

The Daily Press asked readers what they thought about the new rule during a Facebook Saturday Forum.

Some readers said the rule could negatively impact low-income families; other said they don't see an issue in updating information to receive health care.

Elizabeth Wulf, a mental health professional who bills SoonerCare, said the "individual who wrote this rule apparently has never lived in poverty."

"Poverty often makes individuals transient in nature," Wulf wrote. "Many in poverty move multiple times in a year, and it is difficult at times to ensure all mail is transferred to the new home. I feel it would be better served to look for digital verification, such as email or their private SoonerCare login."

In Brent Been's response to the Forum, he said it is bad enough that Gov. Mary Fallin chose not to expand Medicaid, and that he would hate to see families lose coverage. But he also pointed out that fraud can impact taxpayers.

"And at the same time health care fraud has a very costly effect on the taxpayer and beneficiaries," Been wrote. "Of course, it is the responsibility of the insured to keep the Oklahoma Health Care Authority informed of any changes of address."

In a response to another comment that people are too busy worrying about other things in their lives and not the "latest sales flyer" in the mail, David Christie said, "It's pretty obvious somebody is trying to protect" the program so it can continue.

"Whether this is the right way to do it remains to be [seen]," he wrote. "But quite frankly, if you are depending on SoonerCare and equate the responsibility of keeping your insurance active at the same level of receiving sales circulars, you might have a priority problem."

Billy Hunter, a self-described "SoonerCare kid," said the choices parents make shouldn't prevent their children from getting health care.

"I can't imagine what it would have been like to forego trips to the emergency room when I was extremely ill just because of money," Hunter said. "It was a our lifeline - we could never have afforded insurance, and my mom's work didn't offer it."

In an online poll on the Daily Press website, readers were asked what they think of SoonerCare, "the 'insurance' that helps pay for medical and dental care for lower-income families." Out of the 54 respondents, 32 said, "It is an essential program, especially for families with children, and it should be fully funded no matter what."

Nine readers agreed, "It's important for lower-income families, but I believe there is fraud and the federal government should weed that out."

Another 10 said, "I don't believe it's fair, because it seems like people who make just little enough to qualify for SoonerCare get better care than those who work hard and can barely afford insurance or not at all."

Three readers chose the response of, "I do not feel such programs are necessary or in line with what taxpayers want to fund. Those who can't afford health care should only get the very basics."

Learn more

SoonerCare members who have questions or need to update their information can call the SoonerCare Helpline at 800-987-7767 or visit www.mysoonercare.org.

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