Healthcare (Medicaid)

signed · Oklahoma · House May 19, 2025

HB 2052: Health insurance; exemption of certain domestic health maintenance organizations from certain provisions of the Health Maintenance Organizations Act; effective date.

HB 2052 exempts certain domestic health maintenance organizations (HMOs) that exclusively contract with Oklahoma's Medicaid program (via the Oklahoma Health Care Authority) from most state health insurance regulations. These HMOs, which serve only Medicaid recipients and no other patients, are no longer subject to specific provisions of the Health Maintenance Organizations Act, including requirements about benefit coverage and certain administrative rules. The exemption applies solely to services provided to Medicaid recipients under Oklahoma Statutes Title 56, Section 4002.2. The law became effective November 1, 2025, after passing without the Governor's signature.

Topics ✗ HealthcareOpposes HealthcareExempts Medicaid-only HMOs from benefit coverage requirements, reducing regulatory oversight for services to vulnerable patients.85% confidence

Sub-Topics Insurance Medicaid

signed · Oklahoma · House May 11, 2026

HB 2268: Oklahoma Health Care Authority; making an appropriation; effective date; emergency.

HB 2268 requires the Oklahoma Medicaid Program or its contracted entities to reimburse providers for "cognitive assessment and care planning services" (defined using standard medical billing code 99483). This directly affects low-income Medicaid beneficiaries who receive these specific cognitive care services. The bill mandates reimbursement for these services under existing Medicaid rules, with no new funding or eligibility changes. It takes effect November 1, 2025.

Topics ✓ HealthcareSupports HealthcareMandates Medicaid reimbursement for cognitive care services (99483), ensuring continued access for low-income beneficiaries under existing rules without new funding, aligning with improved patient access indicators.95% confidence

Sub-Topics Medicaid

in committee · Oklahoma · Senate Feb 4, 2025

SB 257: Medicaid; creating exception to certain prohibition on contracts with out-of-state providers. Effective date.

SB 257 allows Oklahoma Medicaid to reimburse out-of-state laboratories for specific diagnostic tests when no licensed Oklahoma provider offers those exact services. It amends Oklahoma law (63 O.S. 2021, § 5060) to create an exception to the general prohibition on contracting with out-of-state medical providers. The policy directly affects Medicaid beneficiaries requiring specialized lab services unavailable locally and the Oklahoma Health Care Authority, which must seek federal approval for implementation. The change becomes effective November 1, 2025.

Topics ✓ HealthcareSupports HealthcareEnables Medicaid reimbursement for unavailable specialized lab services, improving patient access to necessary care where local providers don't exist.90% confidence

Sub-Topics Medicaid

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in committee · Oklahoma · Senate Feb 4, 2025

SB 926: State Medicaid program; requiring coverage of insulin and insulin delivery systems; specifying certain covered system. Effective date. Emergency.

SB 926 requires Oklahoma's Medicaid program to cover insulin and insulin delivery systems (including tubeless, wearable insulin pumps) when medically necessary for diabetes management. This directly affects Medicaid beneficiaries with diabetes who rely on these treatments. The bill mandates the Oklahoma Health Care Authority to seek federal approval for this coverage change and takes effect July 1, 2025. It does not alter Medicaid eligibility but ensures specific diabetes-related treatments are covered under the state's Medicaid program.

Topics ✓ HealthcareSupports HealthcareMandates Medicaid coverage for insulin and delivery systems (pumps), expanding access to critical diabetes treatments without restricting benefits.95% confidence

Sub-Topics Medicaid

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in committee · Oklahoma · Senate Feb 4, 2025

SB 1060: Dental benefit plans; establishing formula for medical loss ratio; exempting certain dental plans; requiring annual rebate for certain plan years by certain plans. Effective date.

SB 1060 requires Oklahoma dental benefit plans to spend a minimum percentage of premium revenue on actual dental care (80% for large groups, 75% for individuals/small groups) instead of administrative costs. If plans fail to meet these thresholds, they must issue annual rebates to enrollees by August 1st of the following year. The bill mandates annual reporting to the Insurance Department, including detailed MLR calculations, and exempts Medicaid and state-sponsored plans. It establishes specific formulas for calculating "earned premium" and "medical loss ratio" to ensure transparency and accountability in dental plan spending.

Topics ✓ HealthcareSupports HealthcareRequires dental plans to spend 75-80% of premiums on actual care (not admin), with rebates for failing to meet thresholds, directly protecting enrollee financial interests in healthcare coverage.95% confidence

Sub-Topics Insurance Medicaid

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passed both · Oklahoma · House May 6, 2025

HB 1816: Medicaid; out-of-state medical providers; term; effective date.

HB 1816 requires Oklahoma's Medicaid program to prioritize in-state medical providers for in-person care when local options are available, rather than contracting with out-of-state providers. It specifically applies to services requiring the patient's physical presence and direct provider care (excluding remote services like lab work). The Oklahoma Health Care Authority must seek federal approval to implement this change. The bill takes effect November 1, 2025.

Topics ✓ HealthcareSupports HealthcarePrioritizes in-state Medicaid providers for local care access, improving patient convenience and supporting local healthcare infrastructure without restricting coverage.90% confidence

Sub-Topics Medicaid

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passed both · Oklahoma · Senate Mar 4, 2026

SB 202: Medicaid; modifying eligibility requirements for self-funded or self-insured health care plan to participate in certain premium assistance program. Emergency.

SB 202 modifies eligibility rules for self-funded health plans to participate in Oklahoma's Medicaid premium assistance program. It allows small businesses and public entities using self-funded health plans to qualify if the plan was already used by an employer in the program as of May 1, 2024, or if it’s owned by a local government public trust. This change specifically affects small employers (under 250 employees) and public-sector health plans seeking to access state premium assistance. The bill aims to expand coverage options for low-income workers by making more health plan types eligible for state-funded premium support.

Topics ✓ HealthcareSupports HealthcareExpands Medicaid premium assistance eligibility for small businesses/public entities, increasing access to healthcare coverage under state program.90% confidence

Sub-Topics Insurance Medicaid

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in committee · Oklahoma · Senate Feb 4, 2025

SB 441: Medicaid; requiring certain coverage of chiropractic care; granting additional protections. Effective date. Emergency.

SB 441 requires Oklahoma's Medicaid program to cover medically necessary chiropractic care provided by licensed chiropractors for diagnosing or treating illness/injury or improving bodily function. It prohibits Medicaid from denying coverage based on age and eliminates the need for prior authorization (approval before treatment) for such care. This directly affects Medicaid beneficiaries who require chiropractic services, ensuring they can access this care without age-based barriers or extra administrative hurdles. The bill mandates these changes effective immediately upon enactment, with the Oklahoma Health Care Authority required to seek federal approval for the policy shift.

Topics ✓ HealthcareSupports HealthcareMandates Medicaid coverage for medically necessary chiropractic care, removes age-based denials and prior authorization barriers, expanding access to healthcare services.95% confidence

Sub-Topics Medicaid

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died · Oklahoma · House Feb 7, 2025

HB 1820: Poor persons; Act to Restore Hope, Opportunity, and Prosperity for Everyone; eligibility information; effective date.

HB 1820 requires Oklahoma's Medicaid program to verify specific eligibility information (like income, residency, employment, and immigration status) before approving benefits, excluding TEFRA-eligible applicants and individuals with intellectual disabilities in Home and Community Based Waivers. It mandates quarterly reviews of enrolled Medicaid recipients for changes in circumstances and establishes a 10-business-day window for applicants to respond to discrepancies. The law directs the Oklahoma Health Care Authority to contract with independent vendors that demonstrate cost savings and to use data-sharing agreements with state agencies. This bill directly affects Medicaid applicants and recipients in Oklahoma by tightening eligibility verification processes, while exempting certain vulnerable groups from these requirements.

Topics ✗ HealthcareOpposes HealthcareAdds strict eligibility verification, excludes vulnerable groups (intellectual disabilities in waivers), and mandates frequent reviews, restricting Medicaid access and coverage.95% confidence ✗ ImmigrationOpposes ImmigrationVerifies immigration status for Medicaid eligibility, restricting access for non-citizens not in exempt categories (TEFRA/Intellectual Disability Waivers).90% confidence

Sub-Topics Medicaid

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in committee · Oklahoma · House Feb 4, 2025

HB 2065: Medicaid; reimbursement; multiplex respiratory PCR testing; effective date.

HB 2065 requires Oklahoma Medicaid to reimburse healthcare providers for multiplex respiratory PCR testing (using CPT codes 87636 and 87637) when testing symptomatic patients in emergency rooms or urgent care settings. This bill directly affects hospitals and clinics participating in Oklahoma Medicaid by mandating coverage for tests that detect multiple respiratory viruses simultaneously, including COVID-19, influenza A/B, and RSV. The reimbursement applies to tests aligned with clinical best practices for diagnosing acute respiratory illnesses. The bill takes effect on November 1, 2025.

Topics ✓ HealthcareSupports HealthcareMandates Medicaid reimbursement for multiplex respiratory PCR tests, expanding coverage for diagnostic services in emergency/urgent care settings.95% confidence

Sub-Topics Medicaid

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