An Act
ENROLLED SENATE
BILL NO. 1323 By: Garvin of the Senate
and
McEntire of the House
An Act relating to the state Medicaid program;
authorizing Insurance Department to recognize certain
self-funded or self-insured health care plan as
health care plan under specified conditions; amending
56 O.S. 2021, Section 1010.1, which relates to
premium assistance program; allowing certain self -
funded or self-insured health care plan to
participate in premium assistanc e program under
specified conditions; updating statutory language;
updating statutory reference; providing for
codification; and providin g an effective date.
SUBJECT: Medicaid
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 6012 of Title 36, unless there
is created a duplication in numbering, reads as follows:
A health care plan recognized by the Insurance Department that
participates in the premium assistance program created under Section
1010.1 of Title 56 of the Oklahoma Statutes as of the effective date
of this act that at a lat er date becomes a self-funded or self-
insured health care plan may continue to be recognized by the
Insurance Department as a health care plan if such plan meets the
requirements under subsection J of Se ction 1010.1 of Title 56 of the
Oklahoma Statutes. The health care plan shall only be considered a
health care plan for the exc lusive purposes of the premium
ENR. S. B. NO. 1323 Page 2
assistance program created under Section 1010.1 of Title 56 of the
Oklahoma Statutes.
SECTION 2. AMENDATORY 56 O.S. 2021, Se ction 1010.1, is
amended to read as follows:
Section 1010.1. A. Section 1010.1 et seq. of this title shall
be known and may be cited as the "Oklahoma Medicaid Pr ogram Reform
Act of 2003".
B. Recognizing that many Oklahomans do not have health care
benefits or health care coverage, that many small bu sinesses cannot
afford to provide health care benefits to their em ployees, and that,
under federal law, barriers exi st to providing Medicaid benefits to
the uninsured, the Oklahoma Legislature hereby establish es
provisions to lower the number of uninsured, assist businesses in
their ability to afford health care benefits and coverage for their
employees, and eliminate b arriers to providing health coverage to
eligible enrollees under federal law.
C. Unless otherwise provided by law, the Oklahoma Health Care
Authority shall provide coverage under the state Medicaid program to
children under the age of eighteen (18) years whose family incomes
do not exceed one hundred eighty-five percent (185%) of the federal
poverty level.
D. 1. The Authority is directed to apply for a waiver or
waivers to the Centers for Medicaid Medicare and Medicare Medicaid
Services (CMS) that will a ccomplish the purposes out lined in
subsection B of this section. The Authority is further di rected to
negotiate with CMS to include in the waiver authority provisions to:
a. increase access to health care for Oklahomans,
b. reform the Oklahoma Medicaid Pr ogram to promote
personal responsibility for health care services and
appropriate utilization of health care benefits
through the use of pub lic-private cost sharing,
c. enable small employers, and/or employ ed, uninsured
adults with or without children to p urchase employer-
sponsored, state-approved private, or state -sponsored
ENR. S. B. NO. 1323 Page 3
health care coverage t hrough a state premium
assistance payment plan. If by January 1, 2012, the
Employer/Employee Partnership for Ins urance Coverage
Premium Assistance Program is not consuming more than
seventy-five percent (75%) of its dedicated source of
funding, then the program will be expanded to include
parents of children eligible for Medicaid, and
d. develop flexible health care benefit packages based
upon patient need and cost .
2. The Authority may ph ase in any waiver or waivers it receives
based upon available fundi ng.
3. The Authority is authorized to develop and implement a
premium assistance plan to assist small businesses and/or their
eligible employees to purchase emplo yer-sponsored insurance or "buy-
in" to a state-sponsored benefit plan.
4. a. The Authority is authorized to seek from the Centers
for Medicare and Medicaid Services any waivers or
amendments to existing wai vers necessary to accomplish
an expansion of the p remium assistance program to:
(1) include for-profit employers with two hundred
fifty employees or less up to any level supported
by existing funding resources, and
(2) include not-for-profit employers with five
hundred employees or less up to any level
supported by existing fundin g resources.
b. Foster parents employed by employers with greater t han
two hundred fifty employees shall be exempt from the
qualifying employer requirement p rovided for in this
paragraph and shall be eligible to qualify for the
premium assistance program p rovided for in this
section if supported by existing funding.
E. For purposes of this paragraph, "for-profit employer" shall
mean an entity which is not exe mpt from taxation pursu ant to the
provisions of Section 501(c)(3) of the Internal Revenue Code and
ENR. S. B. NO. 1323 Page 4
"not-for-profit employer" shall mean an entity which is exempt from
taxation pursuant to the provisions of Section 501(c)(3) of the
Internal Revenue Code.
F. The Authority is auth orized to seek from the Centers for
Medicare and Medicaid Services any waive rs or amendments to existing
waivers necessary to accomplish an ext ension of the premium
assistance program to inc lude qualified employees whose family
income does not exceed two h undred fifty percent (250%) of the
federal poverty level, subject to the lim it of federal financial
participation.
G. The Authority is authori zed to create as part of the premium
assistance program an option to purchase a high -deductible health
insurance plan that is compatible with a health savings acco unt.
H. 1. There is here by created in the State Treasury a
revolving fund to be designated the "Health Employee and Economy
Improvement Act (HEEIA) Revolving Fund ".
2. The fund shall be a continuing fund , not subject to fiscal
year limitations, and shal l consist of:
a. all monies received by the Authority pursuant to this
section and otherwise specified or authorized by law,
b. monies received by the Authority due to federal
financial participation pursua nt to Title XIX of the
Social Security Act, and
c. interest attributable to investment of money in the
fund.
3. All monies accruing to the cre dit of the fund are hereby
appropriated and sha ll be budgeted and expended by the Authorit y to
implement a premium assistance plan and to fund the state share for
the Oklahoma Medicaid prog ram on or after the effective date of this
act July 1, 2020, unless otherwise provided by law.
I. 1. The Authority shall establish a procedure for verifying
an applicant’s individual income by utilizing available Oklahoma Tax
Commission records, new hire report data collected by the Oklahoma
ENR. S. B. NO. 1323 Page 5
Employment Security Commissi on, and child support payment data
collected by the Department of Human Services in accordance with
federal and state law.
2. The Oklahoma Tax Commission, Oklahom a Employment Security
Commission, and Department of Human Services shall cooperate in
accordance with federal and state law with the Authority to
establish procedures for the secure electronic tra nsmission of an
applicant’s individual income data to the Au thority.
3. The Department of Public Safety shall cooperate in
accordance with federal and s tate law with the Authority to
establish procedures for the secure electronic transmission of an
applicant’s individual identification data to the Authority.
J. A health care plan participating in the premium assistance
program created under this section as of the effective date of this
act that at a later date becomes a self-funded or self-insured
health care plan may continue to participate in the premium
assistance program if:
1. The health care plan has continuously participated in the
premium assistance program without interruption up to the date it
becomes a self-funded or self-insured health care plan;
2. The self-funded or self-insured health care plan continues
to be recognized as a health care plan by the Insurance Department
under Section 1 of this act;
3. The self-funded or self-insured health care plan continues
to cover all essential health benefits as required by the Centers
for Medicare and Medicaid Services; and
4. The Authority receives the necessary federal appr oval for
self-funded or self-insured health care plans to participate in the
premium assistance program.
SECTION 3. This act shall become effective November 1, 2022.
ENR. S. B. NO. 1323 Page 6
Passed the Senate the 16th day of May, 2022.
Presiding Officer of the Senate
Passed the House of Representatives the 28th day of April, 2022.
Presiding Officer of the House
of Representatives
OFFICE OF THE GOVERNOR
Received by the Office of the Governor this _______ _____________
day of _________________ __, 20_______, at _______ o'clock _______ M.
By: _______________________________ __
Approved by the Governor of the State of Oklahoma this _____ ____
day of _________________ __, 20_______, at _______ o'clock _______ M.
_________________________________
Governor of the State of Oklahoma
OFFICE OF THE SECRETARY OF STATE
Received by the Office of the Secretary of State this _______ ___
day of __________________, 20 _______, at _______ o'clock _______ M.
By: _______________________________ __