Adding the newly eligible adult group to PCMH and increasing care coordination rates for PCMH American Indian/Alaskan Native providers: July 1, 2020, contingent upon CMS approval

With this amendment request, the OHCA seeks approval of the following modifications to the 1115(a) demonstration Special Terms and Conditions (STCs) for the current extension period that will be in effect through the end of the waiver demonstration on December 31, 2023: 

The STCs will be amended to align the 1115(a) demonstration populations with the State Plan to include the adult group to: 

  • Improve access to high-quality, person-centered services that produce positive health outcomes for individuals who were previously under or uninsured.
  • Encourage members to increase utilization of preventive, primary, urgent, and specialty care — accessing the appropriate type of care in the appropriate setting.
  • Decrease reliance on emergency departments for services that would be better provided in lower levels of care settings.
  • Through the use of HANs and HMP, the OHCA will help newly eligible members become more informed about their health condition and health care options, understand appropriate use of the ED, and learn best practices in self-management such that they are empowered to make better informed decisions about their care.
  • Reduce the number of uninsured Oklahomans.

An additional amendment will be made to STC 40 to increase monthly patient-centered medical home (PCMH) care coordination payments to facilities operated by Indian Health Service, tribal facilities, and Urban Indian Clinics (ITUs) to $27.25 per member per month through December 2021, $28.50 per member per month for calendar year 2022, and $29.81 per member per month for calendar year 2023.

The OHCA anticipates the addition of a new Medicaid Eligibility Group (MEG) for the adult group expansion within the existing budget neutrality model. The proposed increase for I/T/U care coordination payments is estimated to equal $16.4 million annually, which is 100% federally funded. 

OHCA will be holding a public hearing on this proposal as follows:   

April 7, 2020 at 2 p.m.
Register for Zoom Meeting:  

The OHCA welcomes comments from the public regarding the amendment to the SoonerCare Choice and Insure Oklahoma 1115(a) Demonstration Waiver program. Please view the waiver amendment in its entirety here: Patient-Centered Medical Home Amendment. The public notice for the waiver amendment can be viewed on the Agency’s Policy Change and Native American Consultation webpages. The amendment will be available for a 30-day public comment period from April 1, 2020 through May 1, 2020. On or after May 16, 2020, comments may also be made at after the amendment has been submitted to CMS. 



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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.