Bill > HB3599

This bill directs the Oklahoma Health Care Authority (OHCA), the state agency that administers Medicaid, to seek federal approval through a Medicaid waiver or a state plan amendment to implement new cost-sharing requirements for certain Medicaid recipients, specifically those considered "expansion enrollees," by January 1, 2027. "Expansion enrollees" likely refers to individuals who have become eligible for Medicaid due to recent expansions in eligibility criteria, often related to income levels. The bill proposes a cost-sharing charge of $35.00 for each instance of care, item, or service received by these expansion enrollees, with the caveat that this amount cannot exceed federal limitations and must comply with eligibility rules outlined in federal law (42 U.S.C. Section 1396a). Importantly, the OHCA is prohibited from lowering the $35.00 cost-sharing for non-emergency use of emergency departments by these enrollees, and the total amount of cost-sharing for a family cannot exceed 5% of their income on a quarterly basis. Participating healthcare providers can require this cost-sharing payment as a condition for providing services, and the amount paid by the enrollee will be deducted from the payment the provider receives from Medicaid, regardless of whether the provider chooses to collect the fee directly. This act is set to become effective on November 1, 2026.

http://www.oklegislature.gov/BillInfo.aspx?Bill=hb3599&Session=2600