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1 STATE OF OKLAHOMA
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2 1st Session of the 60th Legislature (2025)
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3 SENATE BILL 202 By: Daniels
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6 AS INTRODUCED
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7 An Act relating to the state Medicaid program;
7 amending 56 O.S. 2021, Section 1010.1, as last
8 amended by Section 2, Chapter 133, O.S.L. 2024 (56
8 O.S. Supp. 2024, Section 1010.1), which relates to
9 premium assistance program; modifying eligibility
9 requirements for self-funded or self-insured health
10 care plan to participate in premium assistance
10 program; conforming language; updating statutory
11 language; updating statutory references; and
11 providing an effective date.
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14 BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
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15 SECTION 1. AMENDATORY 56 O.S. 2021, Section 1010.1, as
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16 last amended by Section 2, Chapter 133, O.S.L. 2024 (56 O.S. Supp.
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17 2024, Section 1010.1), is amended to read as follows:
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18 Section 1010.1. A. Section 1010.1 et seq. of this title shall
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19 be known and may be cited as the "Oklahoma Medicaid Program Reform
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20 Act of 2003".
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21 B. Recognizing that many Oklahomans do not have health care
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22 benefits or health care coverage, that many small businesses cannot
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23 afford to provide health care benefits to their employees, and that,
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24 under federal law, barriers exist to providing Medicaid benefits to
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Req. No. 340 Page 1
1 the uninsured, the Legislature hereby establishes provisions to
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2 lower the number of uninsured, assist businesses in their ability to
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3 afford health care benefits and coverage for their employees, and
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4 eliminate barriers to providing health coverage to eligible
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5 enrollees under federal law.
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6 C. Unless otherwise provided by law, the Oklahoma Health Care
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7 Authority shall provide coverage under the state Medicaid program to
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8 children under the age of eighteen (18) years whose family incomes
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9 do not exceed one hundred eighty-five percent (185%) of the federal
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10 poverty level.
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11 D. 1. The Authority is directed to apply for a waiver or
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12 waivers to the Centers for Medicare and Medicaid Services (CMS) that
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13 will accomplish the purposes outlined in subsection B of this
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14 section. The Authority is further directed to negotiate with CMS to
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15 include in the waiver authority provisions to:
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16 a. increase access to health care for Oklahomans,
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17 b. reform the Oklahoma state Medicaid Program program to
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18 promote personal responsibility for health care
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19 services and appropriate utilization of health care
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20 benefits through the use of public-private cost
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21 sharing,
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22 c. enable small employers, and/or employed, uninsured
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23 adults with or without children to purchase employer-
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24 sponsored, state-approved private, or state-sponsored
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Req. No. 340 Page 2
1 health care coverage through a state premium
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2 assistance payment plan. If by January 1, 2012, the
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3 Oklahoma Employer/Employee Partnership for Insurance
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4 Coverage premium assistance program is not consuming
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5 more than seventy-five percent (75%) of its dedicated
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6 source of funding, then the program will be expanded
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7 to include parents of children eligible for Medicaid,
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8 and
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9 d. develop flexible health care benefit packages based
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10 upon patient need and cost.
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11 2. The Authority may phase in any waiver or waivers it receives
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12 based upon available funding.
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13 3. The Authority is authorized to develop and implement a
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14 premium assistance plan to assist small businesses and/or their
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15 eligible employees to purchase employer-sponsored insurance or "buy-
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16 in" to a state-sponsored benefit plan.
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17 4. a. The Authority is authorized to seek from the Centers
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18 for Medicare and Medicaid Services any waivers or
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19 amendments to existing waivers necessary to accomplish
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20 an expansion of the premium assistance program to:
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21 (1) include for-profit employers with two hundred
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22 fifty employees or less up to any level supported
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23 by existing funding resources, and
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Req. No. 340 Page 3
1 (2) include not-for-profit employers with five
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2 hundred employees or less up to any level
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3 supported by existing funding resources.
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4 b. Foster parents employed by employers with greater than
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5 two hundred fifty employees shall be exempt from the
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6 qualifying employer requirement provided for in this
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7 paragraph and shall be eligible to qualify for the
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8 premium assistance program provided for in this
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9 section if supported by existing funding.
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10 E. For purposes of this paragraph, "for-profit employer" shall
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11 mean an entity which is not exempt from taxation pursuant to the
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12 provisions of Section 501(c)(3) of the Internal Revenue Code of
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13 1986, as amended, and "not-for-profit employer" shall mean an entity
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14 which is exempt from taxation pursuant to the provisions of Section
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15 501(c)(3) of the Internal Revenue Code of 1986, as amended.
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16 F. The Authority is authorized to seek from the Centers for
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17 Medicare and Medicaid Services any waivers or amendments to existing
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18 waivers necessary to accomplish an extension of the premium
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19 assistance program to include qualified employees whose family
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20 income does not exceed two hundred fifty percent (250%) of the
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21 federal poverty level, subject to the limit of federal financial
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22 participation.
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1 G. The Authority is authorized to create as part of the premium
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2 assistance program an option to purchase a high-deductible health
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3 insurance plan that is compatible with a health savings account.
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4 H. 1. There is hereby created in the State Treasury a
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5 revolving fund to be designated the "Health Employee and Economy
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6 Improvement Act (HEEIA) Revolving Fund".
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7 2. The fund shall be a continuing fund, not subject to fiscal
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8 year limitations, and shall consist of:
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9 a. all monies received by the Authority pursuant to this
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10 section and otherwise specified or authorized by law,
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11 b. monies received by the Authority due to federal
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12 financial participation pursuant to Title XIX of the
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13 Social Security Act, and
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14 c. interest attributable to investment of money in the
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15 fund.
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16 3. All monies accruing to the credit of the fund are hereby
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17 appropriated and shall be budgeted and expended by the Authority to
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18 implement a premium assistance plan and to fund the state share for
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19 the Oklahoma state Medicaid Program program on or after July 1,
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20 2020, unless otherwise provided by law.
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21 I. 1. The Authority shall establish a procedure for verifying
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22 an applicant's individual income by utilizing available Oklahoma Tax
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23 Commission records, new hire report data collected by the Oklahoma
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24 Employment Security Commission, and child support payment data
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1 collected by the Department of Human Services in accordance with
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2 federal and state law.
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3 2. The Oklahoma Tax Commission, Oklahoma Employment Security
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4 Commission, and Department of Human Services shall cooperate in
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5 accordance with federal and state law with the Authority to
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6 establish procedures for the secure electronic transmission of an
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7 applicant's individual income data to the Authority.
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8 3. The Department of Public Safety shall cooperate in
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9 accordance with federal and state law with the Authority to
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10 establish procedures for the secure electronic transmission of an
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11 applicant's individual identification data to the Authority.
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12 J. An employer participating in the premium assistance program
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13 created under this section as of May 1, 2024, may utilize a A self-
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14 funded or self-insured health care plan as a participating health
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15 care plan shall be eligible to participate in the premium assistance
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16 program created under this section if:
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17 1. The self-funded or self-insured health care plan meets at
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18 least one of the following conditions:
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19 a. the plan is utilized by an employer that was
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20 participating in the premium assistance program as of
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21 May 1, 2024, or
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22 b. the plan is owned and operated by an interlocal self-
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23 funded public trust formed under the Oklahoma Statutes
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24 and comprised of local government employers;
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1 2. The self-funded or self-insured health care plan is:
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2 a. recognized by the Insurance Department under Section
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3 6012 of Title 36 of the Oklahoma Statutes, if the plan
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4 meets the conditions of subparagraph a of paragraph 1
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5 of this subsection, or
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6 b. under the oversight of the Office of the Attorney
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7 General, if the plan meets the conditions of
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8 subparagraph b of paragraph 1 of this subsection;
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9 2. 3. The self-funded or self-insured health care plan covers
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10 all essential health benefits as required by the Authority and all
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11 other health benefits required under applicable federal laws;
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12 3. 4. The self-funded or self-insured health care plan
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13 otherwise complies with all applicable federal laws including, but
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14 not limited to, the Employee Retirement Income Security Act of 1974
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15 (ERISA);
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16 4. 5. The self-funded or self-insured health care plan assesses
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17 a monthly premium on members and maintains a rate schedule for
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18 provider employer reimbursement;
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19 5. 6. The self-funded or self-insured health care plan meets
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20 actuarial standards for the premium assistance program as determined
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21 by the Authority and the employer submits an attestation to the
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22 Insurance Department or the Office of the Attorney General, as
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23 applicable, that the self-funded or self-insured health care plan
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24 meets such actuarial standards; and
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1 6. 7. The Authority receives the necessary federal approval for
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2 self-funded or self-insured health care plans to participate in the
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3 premium assistance program.
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4 SECTION 2. This act shall become effective November 1, 2025.
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6 60-1-340 DC 12/30/2024 3:24:51 PM
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Req. No. 340 Page 8Every fact on this page links to its source, starting with the official bill record.