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 non-profit free clinic, has been talking to them to see if they’ll be eligible for free health coverage under the state’s Medicaid expansion that took effect Thursday.
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 (about Medicaid expansion) 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 Thursday as Medicaid expansion took effect and Oklahoma officially 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 populations have access to free or nearly free medical care.
And with the federal government picking up more than 90 percent of the costs, a relatively small amount, $164 million, was needed in state funds to fund the expansion.
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But the state faces another challenge: How do you make sure hundreds of thousands of newly eligible Oklahomans know about their new 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 under the expansion, many of the benefits, such as strengthening the financial health of rural hospitals, adding health care jobs to the state’s economy and improving health outcomes for thousands, will be muted or delayed.
“I think there’s still a large swathe 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.”
126,000 Enrollees and Counting
The Oklahoma Health Care Authority announced Thursday that about 126,000 Oklahomans have enrolled for Medicaid benefits under the expansion since the agency 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 agency has also 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 that began in July. Half of the funds will come from the federal government.
She said this will include setting up 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 starting (this month).”
Medical providers are also stepping up.
Variety Care, a health group with clinics throughout the state, has added counselors at many of their centers to help patients see if they are eligible and then sign up, if so.
Katy Knight, manager of behavioral health and social services with Variety Care, said the non-profit has helped more than 1,400 patients sign up through Medicaid in the last month.
Knight said it’s been a mix so far with some patients having a general idea of what Medicaid expansion is while others may know a little or not much at all.
“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.”
Is Enough Being Done?
But the numbers outline the challenges ahead.
According to the Kaiser Family Foundation, almost 73% of the newly eligible population make below the poverty level. Meanwhile, 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 to reach this population.
Eddie Bennett, assistant director of Weatherford Food and Resource Center, said he estimates that 95% of the center’s clients likely fall in the newly eligible group.
Of the roughly 400 low-income residents he helped serve over the last month, he recalls just a couple asking about the upcoming 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 of the people he sees.
“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.”
Bennett said community groups that serve low-income adults are working to let people know about Medicaid so people can enroll before they need health services. But he said they can only do so much with the resources they have.
“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.”
Can State Leaders Help?
Of the other 37 states that have accepted Medicaid expansion, Oklahoma is one of six states 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 the expansion, at least in the form approved by voters.
Stitt hasn’t not spoken much publicly about expansion, the benefits for the uninsured, the impact on the medical community and 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 the expansion have been at the forefront of pushing residents to enroll.
In Louisiana, for example, their state’s governor, John Bel Edwards, helped host several in-person enrollment and announcements events in 2017 to encourage people to sign up. And a study from the Kaiser Family Foundation found that other states found success when high-profile figures, such as the governor, helped with the 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, saying it can help reach people that otherwise wouldn’t hear about the change.
“I think those campaigns could definitely raise awareness,” said Oklahoma State Medical Association President Dr. Mary Clarke. “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.”
The good news for newly eligible residents is that there is no deadline to get covered under Medicaid.
Whenever someone applies and is approved, their new coverage starts.
As a result, Clarke and other health leaders say the Medicaid expansion outreach and messaging should be providers and leaders throughout the state should continue to work at.
“Health care is a marathon, it will never be a sprint,” she said. “There is always going to be more work to get people enrolled.”