Can SoonerCare Capacity Meet Medicaid Expansion’s Demand?

(Jackie Fortier / StateImpact Oklahoma)

If State Question 802 passes, approximately 200,000 more people will be eligible for SoonerCare, the state’s Medicaid program. Whether SoonerCare can handle the increased patient population is another question.

The Oklahoma Health Care Authority oversees Medicaid for the state. According to the agency’s latest information, SoonerCare is using just under 40% of its total primary care capacity. Even in counties with more than 500 SoonerCare members for each primary care provider there’s unused capacity. So Carter Kimble’s take on the question is surprising. Kimble is the state’s Deputy Secretary of Health and Mental Health.

“As currently structured and the way our health systems are set up and the provider networks we have in place, today we would not have enough capacity,” Kimble said.

But Kimble is considering everything that goes into creating successful health outcomes, including social supports for the low-income people who’d be eligible under Medicaid expansion. And he’s talking about more than just primary care.

“So when I say that there’s not enough capacity, primary care is actually one of the better areas for us,” Kimble said. “There are certain subspecialties that are a real struggle, and especially when you get into…behavioral health.”

That’s certainly something Randy Tate can attest to. He’s the CEO of North Care, a Certified Community Behavioral Health Clinic in Oklahoma City. North Care serves people with severe mental illness and addiction problems. And their $8 million contract with the State Department of Mental Health requires them to see anyone who meets the eligibility criteria, whether they can pay or not.

“We’re doing it [addressing capacity issues] on the backs of our employees and having to bring other resources to the table to be able to do that,” Tate said.

For each of the last three years, North Care has provided over $3 million in uncompensated care under the state contract. And Tate predicts it’ll be the same this year.

“That means we really have artificially low salaries for our staff,” Tate said. “We’re using our investments and interest from those to fill in the gaps. And do a fair amount of fundraising and relying on other resources, like United Way and philanthropic foundations to make ends meet.”

Tate believes Medicaid expansion would help North Care fill in most of that $3 million gap. He’d be able to improve salaries and reduce turnover. But those aren’t the only benefits Tate believes Medicaid expansion would realize.

“We would improve our access and hopefully be able to serve people before they’re in the latter stages of addiction and mental illness, and quickly getting them back into the community and recovering faster and moving on with their lives,” Tate said.

It’s a similar story for physical health. The uninsured put off seeing a doctor because they can’t afford to. So by the time they do, conditions like diabetes, hypertension or heart disease are more advanced. Medicaid expansion would improve access to primary care, where conditions like these could be detected and treated before they have a chance to become severe. And access to primary care is key, says the state’s Carter Kimble.

“Primary care will be the quarterback of coverage,” Kimble said. “The importance there is that if you have that primary care setting, they can easily assist you in coordinating what other needs you may have.”

But specialty care capacity, like primary care, isn’t available as readily from county to county. In states that have expanded Medicaid, coverage has increased markedly. But Medicaid expansion in Oklahoma won’t necessarily address the food, housing, or employment insecurities Kimble believes are important factors in meeting the needs of the Medicaid expansion population.