{"data":{"id":"us-ok/okla.-stat.-tit.-56-56-1011.3","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 56, § 56-1011.3","heading":"Powers, duties and responsibilities of Health Care","body":"Authority – Program opt-out option.\n\nA. The Oklahoma Health Care Authority shall have the following\n\npowers, duties, and responsibilities with respect to the development\n\nof the program established in Section 1011.2 of this title:\n\n1. The consumer education component shall include the\n\nfollowing:\n\na. to develop a choice counseling system to ensure that\n\nthe choice counseling process and related material are\n\ndesigned to provide consumers an understanding of both\n\npublic and private health insurance options provided\n\nby this act including incentives through face-to-face\n\ninteraction, by telephone, and in writing, and through\n\nother forms of relevant media,\n\nb. to develop a system to ensure that there is record of\n\nrecipient acknowledgment that choice counseling has\n\nbeen provided, and\n\nc. to develop a choice counseling system that promotes\n\nhealth literacy and includes an educational component\n\nthat is intended to promote proper utilization of the\n\nhealth care system;\n\n2. The consumer choice component shall include a comprehensive\n\nfeasibility study to allow individuals more choices in their health\n\ncare coverage including, but not limited to, employer-sponsored\n\ninsurance options, and may include the following:\n\na. to develop a system to enable Medicaid consumers to\n\nopt out of their current Medicaid program and purchase\n\nhealth care coverage through their employer-sponsored\n\nhealth insurance plan or access commercial health\n\ninsurance policies for their eligible family members,\n\nb. to develop an actuarially sound average cost per\n\nMedicaid consumer to provide medically necessary\n\nservices. This value shall be used for a voucher\n\nsystem to subsidize Medicaid consumers’ premium costs\n\nfor their employer-sponsored or commercial health\n\ninsurance option,\n\nc. to develop a process for Medicaid consumers to select\n\ncommercial health insurance options, the Oklahoma\n\nHealth Care Authority may develop a plan to implement\n\na personal health account system as an enhanced\n\nbenefit. Monies deposited into a personal health\n\naccount shall only be used by the recipient to defray\n\nhealth-care-related costs including, but not limited\n\nto, copayments, noncovered benefits, and wellness\n\ninitiatives. The Health Care Authority shall\n\npromulgate rules guiding personal health account\n\ntransactions;\n\n3. To provide a grievance-resolution process for Medicaid\n\nconsumers enrolled in a health plan. This process shall include a\n\nmechanism for an expedited review of a grievance if the life of a\n\nMedicaid recipient is in imminent and emergent jeopardy; and\n\n4. To provide a grievance-resolution process for health care\n\nproviders employed by or contracted with a health plan to settle\n\ndisputes among the provider and the health plan or the provider and\n\nthe Oklahoma Health Care Authority.\n\nB. Medicaid consumers electing to opt out of the current\n\nprogram shall be subject to cost-sharing requirements, preexisting-\n\ncondition clauses and the possibility of different benefits of their\n\nemployer-sponsored insurance or selected commercial health care\n\nprovider. The consumer shall also be responsible to pay for any\n\ncost differential between the state subsidy and their premium cost\n\nshould their premium cost be higher. If the cost is lower than the\n\nstate subsidy, then the difference may be placed into a personal\n\nhealth account.\n\nC. Notwithstanding any other provision of this section,\n\ncoverage, cost sharing, and any other component of employer-\n\nsponsored health insurance shall be governed by applicable state and\n\nfederal laws.\n\nD. The Oklahoma Health Care Authority shall develop a system to\n\nensure that the implementation of the provisions of this act do not\n\nnegatively affect the ability of American Indian or Alaska Native\n\nbeneficiaries to access services at Indian Health Service\n\nfacilities, tribally operated health facilities and Urban Indian\nte and\n\nfederal laws.\n\nD. The Oklahoma Health Care Authority shall develop a system to\n\nensure that the implementation of the provisions of this act do not\n\nnegatively affect the ability of American Indian or Alaska Native\n\nbeneficiaries to access services at Indian Health Service\n\nfacilities, tribally operated health facilities and Urban Indian\n\nHealth Programs.\n\nE. The Oklahoma Health Care Authority shall develop a system to\n\nensure that the implementation of the provisions of this act do not\n\nnegatively affect the reimbursement structure between the Oklahoma\n\nHealth Care Authority and the Indian Health Service facilities,\n\ntribally operated health facilities and urban health programs.\n\nF. The Oklahoma Health Care Authority shall develop mechanisms\n\nthrough intergovernmental transfers which will allow tribally\n\noperated facilities that elect to provide services to beneficiaries\n\nother than American Indian or Alaska Native beneficiaries to receive\n\nreimbursement for such services.","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":"194a538e80849dacfb8a3fb6502ba8cab9692e59ed85af15dd11b998f45a263c","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-56-56-1011.25","next":"us-ok/okla.-stat.-tit.-56-56-1011.4"},"notice":"GroundRules: Original legal text. Not legal advice."}