Brenda Wilson is a verified Medicaid application counselor at Variety Care clinic. She helps clients in Anadarko, El Reno and Oklahoma City fill out the online application. Wilson said clients often are confused by the wording when trying to fill it out themselves and give up, which is why the clinic has counselors to help. (Photo by Whitney Bryen/Oklahoma Watch)
Dr. Daniel Joyce has been giving out a different type of news to patients at Lawton’s Hearts That Care Clinic.
Joyce, who runs the nonprofit free clinic, has been talking to them to see if they’ll be eligible for free health coverage under the state’s Medicaid expansion.
Time after time, he’s found many have been shocked – albeit pleasantly so.
“I have one patient who’s been without insurance for about 10 years,” he said. “We got them the information and they came back in tears saying ‘I got approved, is this for real?’”
Nearly a year after voters approved State Question 802, health care leaders and patient advocates celebrated as Oklahoma recently became the 37th state to accept the optional expansion.
This means that hundreds of thousands of Oklahomans who meet the new income eligibility limits – $17,796 for an individual or $36,588 for a family of four – will now be covered under SoonerCare, the state’s Medicaid program. The newly enrolled won’t need to pay any premiums and little-to-no co-pays for their care moving forward.
In a state with the second-highest uninsured rate in the country (next to only Texas), supporters of the expansion say this could be a game-changer in making sure some of the state’s most vulnerable have access to free or nearly free medical care.
And with the federal government picking up more than 90% of costs, a relatively small amount – $164 million – was needed in state funds to fund the expansion.
But the state faces another challenge: How do you make sure hundreds of thousands of newly eligible Oklahomans know about the potentially life-changing benefits?
The stakes are high for both struggling residents and hospitals, especially in rural parts of the state where it’s harder to get the message out. If not enough people sign up, many benefits, including strengthening the financial health of rural hospitals, adding health care jobs and improving health outcomes, will be muted or delayed.
“I think there’s still a large swath of the population that does not know this even exists,” said Oklahoma Hospital Association Executive Director Patti Davis. “Most of us don’t want to think about health care until we need health care, so it may not be top of mind for many people. But that’s why we need multiple communication strategies from different sources, coming from different angles to get the word out.”
The Oklahoma Health Care Authority announced last week that about 126,000 Oklahomans have enrolled since it began accepting applications at the start of June. (Benefits took effect July 1). Melissa Richey, a spokeswoman for the agency, said the “bulk” of those were reprocessed applications from people who had previously applied for Medicaid and were rejected because they earned too much.
Richey said the OHCA also has been working with hospitals, providers and other community service-providers to get the word out. And the agency is paying $500,000 – to Ghost Inc., an Oklahoma City public relations firm, on a marketing campaign. Half of the funds will come from the federal government. This will include billboards, print and digital advertisements, public service announcements and the “full gamut of integrated advertising.”
But there is work to do to meet the state’s projection that 200,000 Oklahomans – accounting for just 60% of the total eligible population – will enroll in the first year.
“We definitely know they are out there,” Richey said. “And we are using the information we’ve been compiling to really target that audience.”
Medical providers also are stepping up.
Variety Care, with clinics throughout the state, has added counselors at many sites to help patients find out if they’re eligible and sign up, if so. Katy Knight, manager of behavioral health and social services, said the nonprofit has helped more than 1,400 people sign up in the last month.
“It’s a relatively short process for most,” she said. “It takes about 20 minutes and they can find out right there and then if they’re approved.”
But challenges lie ahead. Census data shows some of the state’s highest uninsured rates are in rural Oklahoma, where access to health care services and the Internet present challenges. Eddie Bennett, assistant director of Weatherford Food and Resource Center, estimated that 95% of the center’s clients likely fall in the newly eligible group. But of roughly 400 low-income residents he helped serve over the last month, he recalled just a couple asking about the Medicaid changes. Although he said he was excited to learn about the state’s marketing campaign to spread more awareness, he’s worried the messaging won’t reach many.
“For a lot of these people, they don’t have the Internet. They might have a TV or get a newspaper, but that’s it,” he said. “They’re not going to see things on social media or even have the Internet to look things up. If we had money we could do a blitz or whatever you want to call it to send out mail applications and be able to provide information that way, it could be really effective,” he said. “But we just don’t have the funds to do something like that.”
Of the states that have accepted Medicaid expansion, Oklahoma is one of six that passed it though a ballot measure.
Although alternatives to Medicaid expansion were explored over the years, Gov. Kevin Stitt and many other Republican leaders have opposed expansion, at least in the form approved by voters.
Stitt hasn’t spoken much publicly about expansion, benefits for the uninsured, impacts on the medical community or the importance of people signing up. Instead, he focused his health policy efforts this year on converting the entire Medicaid program into a privatized managed care model. That move, which ran into opposition from Democrats, many legislative Republicans and the health community, was recently blocked by the Oklahoma Supreme Court.
In contrast, several Democratic governors in states that passed expansion have been at the forefront of pushing residents to enroll. In Louisiana, Gov. John Bel Edwards helped host several events in 2017 to encourage people to sign up. The Kaiser Family Foundation reported that other states found success when high-profile figures helped with outreach.
But Stitt’s spokeswoman, Carly Atchison, said the governor has no plans on doing any direct outreach.
“Secretary (Kevin) Corbett and OHCA are doing a great job getting information out about Medicaid expansion and our office has not been contacted by any lobbying groups asking for assistance,” she said.
Several health leaders, however, said they would welcome Stitt’s participation and voice.
“We know anyone in a position of power or authority, the more you see them positively acknowledge things, the more people would be willing to try it,” said Oklahoma State Medical Association President Dr. Mary Clarke.
Oklahoma Watch is a nonprofit, nonpartisan news organization that produces in-depth and investigative content on a wide range of issues facing the state. For more Oklahoma Watch content, go to oklahomawatch.org.