{"data":{"id":"us-ok/okla.-stat.-tit.-56-56-1010.1","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 56, § 56-1010.1","heading":"Short title - Oklahoma Medicaid Program Reform Act of","body":"2003 – Purpose - Coverage – Waivers - Health Employee and Economy\n\nImprovement Act (HEEIA) Revolving Fund.\n\nA. Section 1010.1 et seq. of this title shall be known and may\n\nbe cited as the “Oklahoma Medicaid Program Reform Act of 2003”.\n\nB. Recognizing that many Oklahomans do not have health care\n\nbenefits or health care coverage, that many small businesses cannot\n\nafford to provide health care benefits to their employees, and that,\n\nunder federal law, barriers exist to providing Medicaid benefits to\n\nthe uninsured, the Legislature hereby establishes provisions to\n\nlower the number of uninsured, assist businesses in their ability to\n\nafford health care benefits and coverage for their employees, and\n\neliminate barriers to providing health coverage to eligible\n\nenrollees under federal law.\n\nC. Unless otherwise provided by law, the Oklahoma Health Care\n\nAuthority shall provide coverage under the state Medicaid program to\n\nchildren under the age of eighteen (18) years whose family incomes\n\ndo not exceed one hundred eighty-five percent (185%) of the federal\n\npoverty level.\n\nD. 1. The Authority is directed to apply for a waiver or\n\nwaivers to the Centers for Medicare and Medicaid Services (CMS) that\n\nwill accomplish the purposes outlined in subsection B of this\n\nsection. The Authority is further directed to negotiate with CMS to\n\ninclude in the waiver authority provisions to:\n\na. increase access to health care for Oklahomans,\n\nb. reform the Oklahoma Medicaid Program to promote\n\npersonal responsibility for health care services and\n\nappropriate utilization of health care benefits\n\nthrough the use of public-private cost sharing,\n\nc. enable small employers, and/or employed, uninsured\n\nadults with or without children to purchase employer-\n\nsponsored, state-approved private, or state-sponsored\n\nhealth care coverage through a state premium\n\nassistance payment plan. If by January 1, 2012, the\n\nOklahoma Employer/Employee Partnership for Insurance\n\nCoverage premium assistance program is not consuming\n\nmore than seventy-five percent (75%) of its dedicated\n\nsource of funding, then the program will be expanded\n\nto include parents of children eligible for Medicaid,\n\nand\n\nd. develop flexible health care benefit packages based\n\nupon patient need and cost.\n\n2. The Authority may phase in any waiver or waivers it receives\n\nbased upon available funding.\n\n3. The Authority is authorized to develop and implement a\n\npremium assistance plan to assist small businesses and/or their\n\neligible employees to purchase employer-sponsored insurance or “buy-\n\nin” to a state-sponsored benefit plan.\n\n4. a. The Authority is authorized to seek from the Centers\n\nfor Medicare and Medicaid Services any waivers or\n\namendments to existing waivers necessary to accomplish\n\nan expansion of the premium assistance program to:\n\n(1) include for-profit employers with two hundred\n\nfifty employees or less up to any level supported\n\nby existing funding resources, and\nuy-\n\nin” to a state-sponsored benefit plan.\n\n4. a. The Authority is authorized to seek from the Centers\n\nfor Medicare and Medicaid Services any waivers or\n\namendments to existing waivers necessary to accomplish\n\nan expansion of the premium assistance program to:\n\n(1) include for-profit employers with two hundred\n\nfifty employees or less up to any level supported\n\nby existing funding resources, and\n\n(2) include not-for-profit employers with five\n\nhundred employees or less up to any level\n\nsupported by existing funding resources.\n\nb. Foster parents employed by employers with greater than\n\ntwo hundred fifty employees shall be exempt from the\n\nqualifying employer requirement provided for in this\n\nparagraph and shall be eligible to qualify for the\n\npremium assistance program provided for in this\n\nsection if supported by existing funding.\n\nE. For purposes of this paragraph, “for-profit employer” shall\n\nmean an entity which is not exempt from taxation pursuant to the\n\nprovisions of Section 501(c)(3) of the Internal Revenue Code and\n\n“not-for-profit employer” shall mean an entity which is exempt from\n\ntaxation pursuant to the provisions of Section 501(c)(3) of the\n\nInternal Revenue Code.\n\nF. The Authority is authorized to seek from the Centers for\n\nMedicare and Medicaid Services any waivers or amendments to existing\n\nwaivers necessary to accomplish an extension of the premium\n\nassistance program to include qualified employees whose family\n\nincome does not exceed two hundred fifty percent (250%) of the\n\nfederal poverty level, subject to the limit of federal financial\n\nparticipation.\n\nG. The Authority is authorized to create as part of the premium\n\nassistance program an option to purchase a high-deductible health\n\ninsurance plan that is compatible with a health savings account.\n\nH. 1. There is hereby created in the State Treasury a\n\nrevolving fund to be designated the “Health Employee and Economy\n\nImprovement Act (HEEIA) Revolving Fund”.\n\n2. The fund shall be a continuing fund, not subject to fiscal\n\nyear limitations, and shall consist of:\n\na. all monies received by the Authority pursuant to this\n\nsection and otherwise specified or authorized by law,\n\nb. monies received by the Authority due to federal\n\nfinancial participation pursuant to Title XIX of the\n\nSocial Security Act, and\n\nc. interest attributable to investment of money in the\n\nfund.\n\n3. All monies accruing to the credit of the fund are hereby\n\nappropriated and shall be budgeted and expended by the Authority to\n\nimplement a premium assistance plan and to fund the state share for\n\nthe Oklahoma Medicaid Program on or after July 1, 2020, unless\n\notherwise provided by law.\n\nI. 1. The Authority shall establish a procedure for verifying\n\nan applicant’s individual income by utilizing available Oklahoma Tax\n\nCommission records, new hire report data collected by the Oklahoma\n\nEmployment Security Commission, and child support payment data\n\ncollected by the Department of Human Services in accordance with\n\nfederal and state law.\n\n2. The Oklahoma Tax Commission, Oklahoma Employment Security\n\nCommission, and Department of Human Services shall cooperate in\n\naccordance with federal and state law with the Authority to\n\nestablish procedures for the secure electronic transmission of an\n\napplicant’s individual income data to the Authority.\n\n3. The Department of Public Safety shall cooperate in\n\naccordance with federal and state law with the Authority to\n\nestablish procedures for the secure electronic transmission of an\n\napplicant’s individual identification data to the Authority.\n\nJ. An employer participating in the premium assistance program\n\ncreated under this section as of May 1, 2024, may utilize a self-\n\nfunded or self-insured health care plan as a participating health\n\ncare plan if:\n\n1. The self-funded or self-insured health care plan is\n\nrecognized by the Insurance Department under Section 6012 of Title\n\n36 of the Oklahoma Statutes;\ntification data to the Authority.\n\nJ. An employer participating in the premium assistance program\n\ncreated under this section as of May 1, 2024, may utilize a self-\n\nfunded or self-insured health care plan as a participating health\n\ncare plan if:\n\n1. The self-funded or self-insured health care plan is\n\nrecognized by the Insurance Department under Section 6012 of Title\n\n36 of the Oklahoma Statutes;\n\n2. The self-funded or self-insured health care plan covers all\n\nessential health benefits as required by the Authority and all other\n\nhealth benefits required under applicable federal laws;\n\n3. The self-funded or self-insured health care plan otherwise\n\ncomplies with all applicable federal laws including but not limited\n\nto the Employee Retirement Income Security Act of 1974 (ERISA);\n\n4. The self-funded or self-insured health care plan assesses a\n\nmonthly premium on members and maintains a rate schedule for\n\nprovider reimbursement;\n\n5. The self-funded or self-insured health care plan meets\n\nactuarial standards for the premium assistance program as determined\n\nby the Authority and the employer submits an attestation to the\n\nInsurance Department that the self-funded or self-insured health\n\ncare plan meets such actuarial standards; and\n\n6. The Authority receives the necessary federal approval for\n\nself-funded or self-insured health care plans to participate in the\n\npremium assistance program.","path":["OK Code","Title 56"],"source_url":"https://www.oklegislature.gov/OK_Statutes/CompleteTitles/os56.pdf","current_through":"2026-08-14","vintage":"open-us-law v2026.08, retrieved 2026-09-14","retrieved_at":"2026-09-14T18:32:36Z","sha256":"39cc1bd9c69245c361cef99444613dd729a953c73fbf416ca2ac031ba4003414","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-56-56-1009.2","next":"us-ok/okla.-stat.-tit.-56-56-1010.12"},"notice":"GroundRules: Original legal text. Not legal advice."}