Oklahoma Medicaid, SCHIP, & Federal Authority

Health Insurance Flexibility and Accountability (HIFA) Waiver - On September 30, 2005, the Centers for Medicare and Medicaid Services (CMS) approved the Oklahoma Premium Assistance Plan as a HIFA amendment to the existing section 1115 demonstration, SoonerCare. The Oklahoma Employer/Employee Partnership for Insurance Coverage (O-EPIC), rebranded in 2007 as Insure Oklahoma [1], was originally designed to cover an estimated additional 50,000 Oklahoma residents with incomes at or below 185 percent of the federal poverty level (FPL). Oklahoma increased eligibility for adults to 200 percent of the FPL as part of the section 1115 demonstration renewal in 2006. The increased coverage is funded by state general fund revenues generated by a tobacco tax, along with federal matching funds under Title XIX and employer and employee contributions. Insure Oklahoma has two different strategies for covering low-wage workers. The Employer Sponsored Insurance program helps low-wage workers in small Oklahoma firms purchase qualified insurance offered by their employer. The Individual Plan provides health insurance coverage for qualified individuals even if they are not able to obtain coverage through their employer.

Eligible Employer Sponsored Insurance program populations include adults who work for qualified small employers, with 50 or fewer employees, and have incomes above the Medicaid standard, but no more than 200 percent of the FPL and their spouses.  As of April 2008, the employer-sponsored product had 9,416 enrollees and the individual product had just under 2,500 people enrolled.  

Eligible Individual Plan populations include self-employed, unemployed currently seeking work, workers who are not eligible to participate in their employer’s small group health plan, and workers (and their spouses) whose employers do not offer a group health plan and have incomes above the Medicaid standard but no more than 200 percent of the FPL.  Working individuals with disabilities who have incomes above the Medicaid standard, but no more than 200 percent of the FPL are also eligible for the Individual Plan.

To learn more about Insure Oklahoma, read SCI’s Profile in Coverage [2].