Oklahoma’s Medicaid program gets high marks in ‘PERM’ study

By Stacy Martin and Patrick B. McGuigan

Published 15-Jan-2011
In a new analysis, Oklahoma’s Medicaid program (SoonerCare) had one of the lowest Medicaid error rates among states studied, at 1.2 percent. The national average is 8.9 percent, said Jo Kilgore of the Oklahoma Health Care Authority.
In a study of 17 states recently reviewed, the Centers for Medicare & Medicaid Service utilized the Payment Error Rates Measurement (PERM) initiative to assess error rates, and found Oklahoma’s the lowest.
Oklahoma has volunteered to be scrutinized in the PERM program since its 2002 inception. PERM is a comprehensive review of Medicaid services. It measures the error rate in claims payments and identifies ways to correct deficiencies.
OHCA Chief Executive Officer Mike Fogarty said the agency participates because of a commitment to accountability and transparency in use of taxpayer dollars.  Cindy Roberts, OHCA Deputy Chief Executive, told CapitolBeatOK, “This rate is a testament to how efficiently and effectively Oklahoma runs its SoonerCare program. We implement controls year round so we can always operate at an optimum level.”
Roberts said PERM looks at payment and claim processes as well as eligibility determinations for the program.
“This rate showed that almost 99 percent of the time, we were accurate in who and how we paid for services. It is also shows that our providers are billing correctly and we are providing services to those who are qualified for the program,” she noted.
Fogarty credited Medicaid providers with much of the success for their willingness to participate in the Medicaid program.
During last year’s state budget crisis, like all state agencies, the health care authority faced budget cuts. For every state dollar cut, it triggers a $3 loss in federal matching funds. The agency’s state funding reductions last year caused an $89.6 million cut in federal matching funds.
Among the cuts OHCA instituted in response were administrative costs, participant benefits and a 3.25 percent reduction in medical provider payments.
The agency is concerned that could lead some medical providers to drop out of the program, limiting access to those it helps.
Restoring funding that reduced medical provider payments is among the top priorities in the agency’s budget proposal for this legislation session, officials said recently.
However, in terms of projected spending, the state government as a whole faces a tax revenue gap between $225 million and $600 million.
The agency’s information concerning operations and finances are available here.