The Oklahoma Health Care Authority (OKHCA) is an

agency Agency may refer to: Organizations * Institution, governmental or others ** Advertising agency or marketing agency, a service business dedicated to creating, planning and handling advertising for its clients ** Employment agency, a business that ...

of the

government of Oklahoma The government of the U.S. State of Oklahoma, established by the Oklahoma Constitution, is a republican democracy modeled after the federal government of the United States. The state government has three branches: the executive, legislative, and ...

responsible for providing

health insurance Health insurance or medical insurance (also known as medical aid in South Africa) is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance, risk is shared among ma ...

benefits for the state's SoonerCare (Oklahoma Medicaid) members. The Authority is the state-level counterpart to the federal

Centers for Medicare and Medicaid Services The Centers for Medicare & Medicaid Services (CMS), is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer M ...

. The Authority is led by a Board of Directors, composed of seven members appointed by the

Governor of Oklahoma The governor of Oklahoma is the head of government of the U.S. state of Oklahoma. Under the Oklahoma Constitution, the governor serves as the head of the Oklahoma Executive (government), executive branch, of the government of Oklahoma. The gove ...

, the

President pro tempore of the Oklahoma Senate The President ''pro tempore'' of the Oklahoma Senate is the second-highest-ranking official of the Oklahoma Senate and the highest-ranking state senator. The Oklahoma Constitution designates the Lieutenant Governor of Oklahoma as the highest-r ...

, and the

Speaker of the Oklahoma House of Representatives The Speaker of the Oklahoma House of Representatives is the speaker (politics), presiding officer of the lower house of the Oklahoma Legislature, the Oklahoma House of Representatives. The speaker exercises administrative and procedural functions ...

. The Governor appoints the Administrator of the Authority, who serves as the chief executive officer of the Authority, with the consent of the Senate. The Administrator serves at the pleasure of the Governor. The Authority was created in 1993 during the term of Governor

David Walters David Lee Walters (born November 20, 1951) is an American politician who was the 24th governor of Oklahoma from 1991 to 1995. Born in Canute, Oklahoma, Walters was a project manager for Governor David Boren and the youngest executive officer w ...

Leadership

The Oklahoma Health Care Authority is led by CEO, Rebecca Pasternik-Ikard under the direction of the Board of Directors. The Board of Directors is the governing body of OHCA, which directs the actions and oversees the operation of the Authority. The Board is composed of seven members, with three appointed by the

, two appointed by the

, and two appointed by the

. Board members serves a four-year term without compensation. In making the appointments, the considerations must be given to urban, rural, gender and minority representation. As of 2014, the current members of the Board are:

Duties

The Oklahoma Health Care Authority has the primary duty of executing ''SoonerCare'', the Oklahoma version of

Medicaid Medicaid in the United States is a federal and state program that helps with healthcare costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, including nursing home care and pers ...

. SoonerCare is a health coverage program jointly funded by the

United States federal government The federal government of the United States (U.S. federal government or U.S. government) is the Federation#Federal governments, national government of the United States, a federal republic located primarily in North America, composed of 50 ...

and the Oklahoma state government. The program provides payments to cover medical services to economically challenged individuals. OHCA determines financial eligibility for the program.

SoonerCare

''SoonerCare'' is medical care delivered by OHCA as prescribed by the

Social Security Act of 1965 The Social Security Amendments of 1965, , was legislation in the United States whose most important provisions resulted in creation of two programs: Medicare and Medicaid. The legislation initially provided federal health insurance for the elde ...

(''the Medicaid Act''). The Federal Medicaid Act requires that certain medical services be delivered to recipients by hospitals and physicians. The State, however, is allowed to add other optional services, such as pharmacy services. With each of these programs, OHCA is responsible for setting compensation levels, services contained in each delivery system, contracts to deliver the services, and actuarial determinations regarding compensation. As of February 2012, those individuals covered by HCA comprise approximately 879,033 individuals across Oklahoma. In order to be eligible to receive ''SoonerCare'' medical services from OHCA, an individual must meet any of the following requirements: *Adults with children under 19 *Children under 19 and pregnant women *Individuals 65 and older *Individuals who are blind or who have disabilities *Women under 65 in need of breast or cervical cancer treatment *SoonerPlan - Men and women 19 and older with family planning needs SoonerCare is a

means test A means test is a determination of whether an individual or family is eligible for government assistance or welfare, based upon whether the individual or family possesses the means to do without that help. Canada In Canada, means tests are use ...

ed program. State law provides that SoonerCare may cover individuals who have an annual income of equal to or less than 185% of the United States

federal poverty level In the United States, poverty has both social and political implications. In 2020, there were 37.2 million people in poverty. Some of the many causes include income inequality, inflation, unemployment, debt traps and poor education.Western, B ...

. OHCA contracts with

Oklahoma Department of Human Services The Oklahoma Department of Human Services (OKDHS) is an agency of the government of Oklahoma. Under the supervision of the Oklahoma Secretary of Health and Human Services, OKDHS is responsible for providing help to individuals and families in nee ...

to determine eligibility for OHCA services. Additionally, OHCA actively works with the

Office of the Oklahoma Attorney General The Office of the Attorney General (OAG) is an agency of the Oklahoma state government that is headed by the Attorney General of Oklahoma. The OAG is responsible for supervising the administration of justice across the State, providing legal ass ...

's ''Medicaid Fraud Unit'' to prosecute fraudulent providers. In September 2010, OHCA implemented an online system that uses an "enroll-first, verify-later" approach that automatically renews benefits for existing SoonerCare beneficiaries and enrolls new applicants if the system determines that they are likely to meet eligibility requirements. The program has streamlined enrollment processes, saving an estimated $1.5 million in operating costs and reducing the rate of those uninsured.

Insure Oklahoma

Insure Oklahoma is an employer sponsored insurance plan administered by OHCA which provides employers with premium subsidies to help buy health insurance for low to moderate income employees. Insure Oklahoma also provides a way for individuals who participate in the Individual Plan to gain access to an affordable health care option. In April 2004, Senate Bill 1546 authorized the Oklahoma Health Care Authority to develop a program assisting employees of small businesses, 19 to 64 years of age with either: *a portion of their private health plan premiums (Employer Sponsored Insurance), or *the purchase of a state sponsored health plan operated under the state Medicaid program (Individual Plan). In November 2004, the Oklahoma Health Care Initiative created the funding mechanism to fund Insure Oklahoma. SQ 713, passed by a statewide vote, increased the

sales tax A sales tax is a tax paid to a governing body for the sales of certain goods and services. Usually laws allow the seller to collect funds for the tax from the consumer at the point of purchase. When a tax on goods or services is paid to a govern ...

on tobacco products. A portion of these revenues were designated to be used to fund the new health program.

Organization

The Authority is divided into four service branches: Soonercare Operations, Financial Services, Information Services, and Legal Services. *Office of the Administrator - led by the Administrator of the Authority, immediate staff of the Administrator and provides policy direction for Authority and support to Board of Directors **Administrative Services - led by Administrator's Chief of Staff **Civil Rights/Freedom of Information Act Office **Policy, Planning and Integrity Office - led by Deputy Chief Executive Officer **Communications, Outreach and Reporting Office - led by Deputy Chief Executive Officer *SoonerCare Operations - led by Deputy State Medicaid Director **Medical Professional Support **Program Operations and Benefits **Quality Assurance/Quality Improvement **Opportunities for Living Life **Insure Oklahoma *Financial Services - led by Chief Financial Officer *Information Services - led by Chief Information Officer *Legal Services - led by General Counsel

Budget and Staff

The Oklahoma Health Care Authority has an annual budget over $5 billion, making OHCA one of the largest state agencies. OHCA also employs over 400 full-time employees.

References

External links

Oklahoma Health Care Authority official websiteInsure Oklahoma official website
{{DEFAULTSORT:Oklahoma Health Care Authority Health Care Authority Health Care Authority 1993 establishments in Oklahoma