Okla. Stat. tit. 56, § 56-1010.1

2003 – Purpose - Coverage – Waivers - Health Employee and Economy

Improvement Act (HEEIA) Revolving Fund.

A. Section 1010.1 et seq. of this title shall be known and may

be cited as the “Oklahoma Medicaid Program Reform Act of 2003”.

B. Recognizing that many Oklahomans do not have health care

benefits or health care coverage, that many small businesses cannot

afford to provide health care benefits to their employees, and that,

under federal law, barriers exist to providing Medicaid benefits to

the uninsured, the Legislature hereby establishes provisions to

lower the number of uninsured, assist businesses in their ability to

afford health care benefits and coverage for their employees, and

eliminate barriers 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 Medicare and Medicaid Services (CMS) that

will accomplish the purposes outlined in subsection B of this

section. The Authority is further directed 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 Program to promote

personal responsibility for health care services and

appropriate utilization of health care benefits

through the use of public-private cost sharing,

c. enable small employers, and/or employed, uninsured

adults with or without children to purchase employer-

sponsored, state-approved private, or state-sponsored

health care coverage through a state premium

assistance payment plan. If by January 1, 2012, the

Oklahoma Employer/Employee Partnership for Insurance

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

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d. develop flexible health care benefit packages based

upon patient need and cost.

2. The Authority may phase in any waiver or waivers it receives

based upon available funding.

3. The Authority is authorized to develop and implement a

premium assistance plan to assist small businesses and/or their

eligible employees to purchase employer-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 waivers necessary to accomplish

an expansion of the premium 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
uy-

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 waivers necessary to accomplish

an expansion of the premium 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 funding resources.

b. Foster parents employed by employers with greater than

two hundred fifty employees shall be exempt from the

qualifying employer requirement provided for in this

paragraph and shall be eligible to qualify for the

premium assistance program provided 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 exempt from taxation pursuant to the

provisions of Section 501(c)(3) of the Internal Revenue Code and

“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 authorized to seek from the Centers for

Medicare and Medicaid Services any waivers or amendments to existing

waivers necessary to accomplish an extension of the premium

assistance program to include qualified employees whose family

income does not exceed two hundred fifty percent (250%) of the

federal poverty level, subject to the limit of federal financial

participation.

G. The Authority is authorized 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 account.

H. 1. There is hereby 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 shall consist of:

a. all monies received by the Authority pursuant to this

section and otherwise specified or authorized by law,

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b. monies received by the Authority due to federal

financial participation pursuant 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 credit of the fund are hereby

appropriated and shall be budgeted and expended by the Authority to

implement a premium assistance plan and to fund the state share for

the Oklahoma Medicaid Program on or after 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

Employment Security Commission, and child support payment data

collected by the Department of Human Services in accordance with

federal and state law.

2. The Oklahoma Tax Commission, Oklahoma 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 transmission of an

applicant’s individual income data to the Authority.

3. The Department of Public Safety shall cooperate in

accordance with federal and state law with the Authority to

establish procedures for the secure electronic transmission of an

applicant’s individual identification data to the Authority.

J. An employer participating in the premium assistance program

created under this section as of May 1, 2024, may utilize a self-

funded or self-insured health care plan as a participating health

care plan if:

1. The self-funded or self-insured health care plan is

recognized by the Insurance Department under Section 6012 of Title

36 of the Oklahoma Statutes;
tification data to the Authority.

J. An employer participating in the premium assistance program

created under this section as of May 1, 2024, may utilize a self-

funded or self-insured health care plan as a participating health

care plan if:

1. The self-funded or self-insured health care plan is

recognized by the Insurance Department under Section 6012 of Title

36 of the Oklahoma Statutes;

2. The self-funded or self-insured health care plan covers all

essential health benefits as required by the Authority and all other

health benefits required under applicable federal laws;

3. The self-funded or self-insured health care plan otherwise

complies with all applicable federal laws including but not limited

to the Employee Retirement Income Security Act of 1974 (ERISA);

4. The self-funded or self-insured health care plan assesses a

monthly premium on members and maintains a rate schedule for

provider reimbursement;

5. The self-funded or self-insured health care plan meets

actuarial standards for the premium assistance program as determined

by the Authority and the employer submits an attestation to the

Insurance Department that the self-funded or self-insured health

care plan meets such actuarial standards; and

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6. The Authority receives the necessary federal approval for

self-funded or self-insured health care plans to participate in the

premium assistance program.