Waiver Projects Currently Undergoing Application, Renewal, or Amendment 

Purpose of this Webpage 

In accordance with federal and state law, the Oklahoma Health Care Authority as a single state Medicaid agency, must notify the public of its intent to submit to the Centers for Medicare and Medicaid Services (CMS) any new 1115 demonstration waiver project or extension renewal or amendment to any previously approved demonstration waiver project and must make available at least a 30-day public comment period at minimum 30 days prior to submitting to CMS the new 1115 demonstration waiver project or extension renewal or amendment.

Public notices, including the description of the new 1115 Demonstration Waiver project or, extension renewal or amendment to an existing demonstration waiver project to be submitted to CMS, will be posted here along with links to the full public notice and the application/extension/amendment document to be submitted to CMS.

The full public notices will include:

  • the address, telephone number and internet address where copies of the new demonstration waiver project or extension or amendment document is available for public review and comment; 
  • the postal address where written comments can be sent;  
  • the minimum 30-day time period in which comments will be accepted;  
  • the locations, dates and times of at least two public hearings convened by the State to seek input, (At least one of the two required public hearings will use telephonic and/or web conference capabilities to ensure statewide accessibility to the public hearing.);
  • and a link to the CMS website to access comments received by CMS during their 30-day public comment period after the application/extension/amendment has been submitted to CMS.

Comments may be provided during scheduled public hearings or in writing during the public comment period. To submit comments, write to

Oklahoma Health Care Authority
Federal and State Policy Division
4345 N. Lincoln Blvd,
Oklahoma City, OK 73105 

Locations, dates and times for public hearings will be published on the upcoming public hearings page of this website.

If you need this material in an alternative format, such as large print, please contact the Communications Division at 405-522-7300.

SoonerCare Choice and Insure Oklahoma 1115 Demonstration Waiver Public Notice and Amended Application

Added 08/31/17
View or print the extension renewal request application to be submitted to CMS for SoonerCare Choice and Insure Oklahoma 1115 Demonstration Waiver 

Public Notice 

Added 08/31/17
 View or print public comments regarding SoonerCare Choice and Insure Oklahoma 1115 Demonstration Waiver extension renewal request application  

Added 08/31/17
View or print the SoonerCare Choice and Insure Oklahoma 1115 Demonstration Waiver and Post Award Forum Public Hearing Presentation

Added 08/31/17
View or print the public notice regarding the extension renewal request for the SoonerCare Choice and Insure Oklahoma 1115 Demonstration Waiver  

The Oklahoma Health Care Authority (OHCA) as the single state Medicaid agency is providing public notice of its intent to submit to the Centers of Medicare and Medicaid Services (CMS) a written request to amend the SoonerCare Choice and Insure Oklahoma 1115 Demonstration waiver and to hold public hearings to receive comments on the extension renewal request to the Demonstration.

The State will request an amendment to the SoonerCare Choice and Insure Oklahoma 1115 Demonstration waiver to remove the pilot status of the Health Access Networks (HAN) to allow the possibility of statewideness. Statewideness in accordance with Section 1902(a)(1) will also be removed from the waiver list.  

The State does not request any additional waivers to implement the changes to the Demonstration:

The State will seek to eliminate the following waiver and expenditure authorities related to its Health Access Network statewideness:  

  •  Statewideness/Uniformity Section
     
    § 1902(a)(1)
     To enable the state to provide Health Access Networks (HANs) only in certain geographical areas of the State.

In addition, the second, of two public meetings described below, will also serve as the 2017 Post Award Forum to allow any discussion or feedback regarding the waiver. 

Waiver List

  • § 1902(a)(23)(A)
    To enable the state to restrict beneficiaries’ freedom of choice of care management providers, and to use selective contracting that limits freedom of choice of certain provider groups to the extent that the selective contracting is consistent with beneficiary access to quality services. No waiver of freedom of choice is authorized for family planning providers.
  • § 1902(a)(34)
    To enable the state to waive retroactive eligibility for demonstration participants, with the exception of Tax Equity and Fiscal Responsibility Act (TEFRA) and Aged, Blind, and Disabled populations.

Expenditure Authorities

  • Demonstration Population 5. Expenditures for health benefits coverage for individuals who are “Non-Disabled Low Income Workers” age 19–64 years who work for a qualifying employer and have no more than 200 percent of the federal poverty level (FPL), and their spouses.  
  • Demonstration Population 6. Expenditures for health benefits coverage for individuals who are “Working Disabled Adults” 19-64 years of age who work for a qualifying employer and have income up to 200 percent of the FPL.
  • Demonstration Population 8. Expenditures for health benefits coverage for no more than 3,000 individuals at any one time who are full-time college students age 19 through age 22 and have income not to exceed 200 percent of the FPL, who have no creditable health insurance coverage, and work for a qualifying employer.
  • Demonstration population 10. Expenditures for health benefits coverage for foster parents who work for an eligible employer and their spouses with household incomes no greater than 200 percent of the FPL.
  • Demonstration Population 11. Expenditures for health benefits coverage for individuals who are employees and spouses of not-for-profit businesses with 500 or fewer employees, work for a qualifying employer, and with household incomes no greater than 200 percent of the FPL.
  • Demonstration Population 12. Expenditures for health benefits coverage for individuals who are “Non-Disabled Low Income Workers” age 19–64 years whose employer elects not to participate in the Premium Assistance Employer Coverage Plan, who are self-employed, or unemployed, and have income up to 100 percent of the FPL, and their spouses.
  • Demonstration Population 13. Expenditures for health benefits coverage for individuals who are “Working Disabled Adults” 19-64 years of age whose employer elects not to participate in the Premium Assistance Employer Coverage Plan, as well as those who are self-employed, or unemployed (and seeking work) and who have income up to 100 percent of the FPL.
  • Demonstration Population 14. Expenditures for health benefits coverage for no more than 3,000 individuals at any one time who are full-time college students age 19 through age 22 and have income not to exceed 100 percent of the FPL, who have no creditable health insurance coverage, and do not have access to the Premium Assistance Employer Coverage Plan.
  • Demonstration Population 15. Expenditures for health benefits coverage for individuals who are working foster parents, whose employer elects not to participate in Premium Assistance Employer Coverage Plan and their spouses with household incomes no greater than 100 percent of the FPL.
  • Demonstration Population 16. Expenditures for health benefits coverage for individuals who are employees and spouses of not-for-profit businesses with 500 or fewer employees with household incomes no greater than 100 percent of the FPL, and do not have access to the Premium Assistance Employer Coverage Plan.
  • Health Access Networks Expenditures. Expenditures for Per Member Per Month payments made to the Health Access Networks for case management activities.
  • Premium Assistance Beneficiary Reimbursement. Expenditures for reimbursement of costs incurred by individuals enrolled in the Premium Assistance Employer Coverage Plan and in the Premium Assistance Individual Plan that are in excess of five percent of annual gross family income.
  • Health Management Program. Expenditures for otherwise non-covered costs to provide health coaches and practice facilitation services through the Health Management Program.
  • Work Force Development Supplemental Payments to State Teaching Universities.Expenditures for reimbursement to state teaching universities to grow and improve the healthcare workforce in Oklahoma. 

The State continues to evaluate whether it will request other waivers or expenditure authorities.

The extension renewal to the Demonstration will further the objectives of Title XIX by providing a medical home and premium assistance insurance across the continuum of coverage. The removal of the pilot status of the Health Access Networks, this will allow for statewideness of the program.

This extension renewal will be statewide and will operate from calendar years 2019 through 2021. The State anticipates that this extension renewal will affect most of the approximately 545,858 SoonerCare Choice individuals covered under the Demonstration as of June 2017.

The Demonstration extension renewal, including the proposed amendment, will test hypotheses related to access to care, quality of care management, integration of Indian Health Services, and access to affordable health insurance. The State expects that, over the life of the Demonstration, covering SoonerCare Choice enrollees will be comparable to what the costs would have been for covering the same group of Oklahomans using traditional Medicaid. The State does not anticipate that the extension renewal to the Demonstration will affect its current waiver trend rate or per capita cost estimates, which can be found in the Demonstration Populations table below.

The information in the table below is provided by The Pacific Health Policy Group (PHPG) which has been retained by the OHCA as an independent contractor. The information is pulled from the Budget Neutrality exhibits which incorporate full-year enrollment and expenditure data through calendar year 2016 (demonstration year 21). Expenditures reflect C-Report amounts.

Projections for the remainder of the current extension period are based on Medicaid Eligibility Group (MEG) specific assumptions, as described in detail throughout the chapter.  Updates to worksheets previously submitted are described in text boxes included at the top of each worksheet (where applicable).  Traditional MEG projections for 2018 incorporate the CMS-mandated rebasing methodology, with 1) the budget neutrality PMPM set equal to the 2016 actual PMPM, trended to 2018 and 2) savings limited to a five-year look back period. Annual aggregate savings/ (deficit) projections for 2019 – 2021 are capped at 25 percent of actual prior to being added to cumulative savings/ (deficit) projections.

 Demonstration Populations

 Trend

DY 23 (2018) projection PMPM

DY 24 (2019) projection PMPM

DY 25 (2020) projection PMPM

DY 26 (2021) projection PMPM

TANF-Urban

 4.40%

 $256.79

 $268.56

 $280.43

 $292.82

TANF-Rural

 4.40%

 $226.92

 $238.32

 $248.75

 $259.64

ABD-Urban

 4.20%

 $1,121.61

 $1,170.14

 $1219.23

 $1270.38

ABD-Rural

 4.20%

 $1,091.15

 $1,138.39

 $1,186.15

 $1,235.91

Non-Disabled Working Adults (Employer Plan)

 4.40%

 $326.90

 $341.28

 $356.29

 $371.97

Disabled Working Adults (Employer Plan)1

 4.20%

 $0

 $0

 $0

 $0

TEFRA Children

 4.20%

 $777.48

 $810.14

 $844.16

 $879.62

CHIP Medicaid Expansion Children2  


 

 $0

 $0

 $0

 $0

Full-Time College Students (Employer Plan)

 4.40%

 $261.27

 $272.76

 $284.77

 $297.30

Foster Parents (Employer Plan)3 

 

 $0

 $0

 $0

 $0

Not-for-Profit Employees (Employer Plan)3

 

 $0

 $0

 $0

 $0

Non-Disabled Working Adults (Individual Plan)

 

 $592.84

 $618.93

 $646.16

 $674.59

Disabled Working Adults (Individual Plan)

 

 $4,737.34

 $4,936.31

 $5,143.63

 $5,359.66

Full-Time College Students (Individual Plan)

 

 $197.21

 $205.88

 $214.94

 $224.40

Foster Parents (Individual Plan)3

 

$0

$0

$0

$0

Not-for-Profit Employees (Individual Plan)3

 

$0

$0

$0

$0

  • Demonstration Year (DY) 
  • Per Member Per Month (PMPM)

1All WDA enrollment has occurred within the IP component of the program.  

2One additional population, CHIP Medicaid Expansion, is reported separately in the Budget Neutrality per PHPG. 

3The OHCA is not projecting any enrollment for this MEG during the renewal period.

View or print the extension renewal request application to be submitted to CMS for SoonerCare Choice andInsure Oklahoma 1115 Demonstration Waiver

The Demonstration application may also be viewed from 8 AM – 4:00 PM Monday through Friday at:

Oklahoma Health Care Authority
Federal and State Policy Division
4345 N. Lincoln Blvd,
Oklahoma City, OK 73105
Contact: Sherris Harris-Ososanya 

Public comments may be submitted until midnight on Friday, September 22, 2017. Comments may be submitted by agency blog to comments box or by regular mail to

Oklahoma Health Care Authority
Federal and State Policy Division
4345 N. Lincoln Blvd, Oklahoma City, OK 73105   

 View comments that others have submitted.

Comments may also be viewed at the OHCA Public Webpage.

The State held two public hearings during the public comment period.

SoonerCare Choice and Insure Oklahoma Waiver Extension Renewal Public Hearing
July 11, 2017 at 5:00p.m. 
The Child Health Workgroup, 
OU Robert Bird Library
First Floor Conference Room
Oklahoma City, OK 73104. 

Videoconferencing will be available for this meeting:  

  •  OU College of Medicine, Tulsa;
  •  Northwestern Oklahoma State University, Enid;
  •  Eastern Oklahoma State University, Wilburton and
  •  Stillwater Medical Center

SoonerCare Choice and Insure Oklahoma Waiver Extension Renewal Public Hearing
September 21, 2017 at 1:00p.m. 
Medical Advisory Committee Meeting
Ed McFall Boardroom 
Oklahoma Health Care Authority 
4345 N. Lincoln Blvd, Oklahoma City, OK.

Videoconferencing will be available for this meeting.

Please submit comments via the comment box below.




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Please note that all comments must be reviewed and approved prior to posting. Approved comments will be posted Monday through Friday between the hours of 7:30 a.m. – 4 p.m. Any comments received after 4 p.m. will be posted on the following business day.