09/2023

Oklahoma Ruling regarding Medicare Supplements

The Oklahoma Insurance Department issued a ruling regarding movement between Medicare Supplements.  In the past you would not be able to move from one supplement to another without passing a health statement.  Going forward, you will be allowed to move for your beginning of your birthday month, without a health statement, to a same or lesser benefit plan (i.e., G to N or G+ to G, etc).  Medicare Supplement carriers are still working to determine how this will look and work.  More details will be made available when some of these decisions have been made.

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07/2022

Public Health Emergency (PHE)

At the beginning of the COVID-19 pandemic, the federal government declared a public health emergency (PHE). During the PHE, we are required to continue SoonerCare coverage for all members even though there are some members who no longer qualify for benefits.

Example of reasons why a member may no longer qualify for benefits:

• Your salary is now higher than the required amount to receive SoonerCare benefits.

• Someone has moved in or out of your household.

• Your contact information and/or documents are not updated at mysoonercare.org.

It was recently announced the PHE is extended another 90 days. This means members, who typically wouldn’t qualify for benefits possibly due to the reasons above, will continue to receive their SoonerCare benefits until October 31st.

There will come a time when the PHE will end. Once we know the day, we will send notifications to those people who no longer will receive SoonerCare benefits. Those members determined to be ineligible for benefits will be removed from SoonerCare in phases focusing on the member’s benefit utilization and critical health issues.

Members who are ineligible will receive three notices:

• An initial notification letter will be mailed once the end of the PHE is announced. This notification letter will detail the specific end date of benefits for those determined ineligible. It is important you update your mailing address at mysoonercare.org as soon as possible, so you receive this notification.

• A second notice will be sent to ineligible members 45 days prior to their scheduled end date to inform them of the reason for loss of eligibility, potentially missing documents to verify eligibility and appeal rights.

• A third notice will then go out 10 days before the ineligible member loses eligibility.

Members should take time to think about their health care needs and plan in case their SoonerCare coverage ends. Please go to mysoonercare.org to learn more.

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04/2022

Income Guidelines for Insure Oklahoma changed (AGAIN) effective 04/01/2022:

2022 Insure Oklahoma ESI Income Guidelines

SIZE OF                MINIMUM                                         MAXIMUM                                 MAXIMUM 

HOUSEHOLD       MONTHLY INCOME                         MONTHLY INCOME                  ANNUAL INCOME

1                           $1,576                                               $2,572                                      $30,864

2                           $2,122                                               $3,465                                      $41,580

3                           $2,670                                               $4,359                                      $52,308

4                           $3,216                                               $5,251                                      $63,012

5                           $3,763                                               $6,143                                      $73,716

6                           $4,309                                               $7,037                                      $84,444

7                           $4,856                                               $7,930                                      $95,160

8                           $5,402                                               $8,822                                      $105,864

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07/2021

Coming Soon - Special Enrollment in marketplace for Unemployment recipients

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05/01/2021

Medicaid Expansion vs Insure Oklahoma

We have investigated the changes to Insure Oklahoma, effective as of 06/30/2021 and we wanted to share what we have discovered.

Our understanding is that your employees, who are currently covered by Insure Oklahoma subsidy, will lose that subsidy effective 06/01/2021 if their income is at or below 133% of the Federal Poverty Level (FPL).  Based on the chart below, employees must have an annual, total household income between 133% - 200% of the FPL, to continue to qualify for Insure Oklahoma subsidies.

If an employee chooses not to accept the SoonerCare enrollment, they may stay on the employer provided group health plan without receiving subsidy discounts, meaning the employer loses that subsidy.

That FPL guideline for all states except Alaska and Hawaii is:

Household size                         Poverty Guideline Minimum (@133%)                       Maximum Income for Insure Oklahoma (@200%)

1                                                    $17,130.40                                                               $29,256

2                                                    $23,168.60                                                               $39,564

3                                                    $29,206.80                                                               $49,860

4                                                    $35,245.00                                                               $60,180

5                                                    $41,283.20                                                               $70,476

6                                                    $47,321.14                                                               $80,772

7                                                    $53,359.60                                                               $91,092

8                                                    $59,397.80                                                             $102,256

For families/households with more than 8 persons, add $6,038.20 for each additional person

It would be imperative for any of your employees current receiving reduced rates due to subsidy, to verify their household income to be sure whether they will still qualify for Insure Oklahoma subsidy, or if they will be forced off your group health plan and be moved to SoonerCare.

Your employees cannot apply for Marketplace (Healthcare.gov) coverage, since you offer an affordable plan.  Be sure they know that and we can help communicate that if needed. 

This message may not cover all the things you should know about the Medicaid expansion, but it is a first step to understand what is happening.  Feel free to reach out to us if you have additional questions or concerns about your employee’s eligibility. 

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04/01/2021

New Oepic Income Guidelines

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03/11/2021

American Rescue Plan Act of 2021 and New Special Election Period (SEP) for Marketplace/Healthcare.gov

Highlights:

• No cost for COBRA from 04/01/2021 until 09/30/2021

• Approved for 2021 and 2022

• Unemployment recipients will be able to receive the maximum subsidy available, regardless of their annual income

• Marketplace participants can re-enroll with a Life Change, to receive better subsidies and possibly cost share reductions for medical deductibles and out-of-pocket amounts.  Please reach out to us if you would like to pursue this.  The SEP runs until 08/15/2021.

• Underestimated income for 2020 subsidy will not have to pay back the APTC at 2021 tax filing

• Larger subsidies for those 133 - 400% of the federal poverty level

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For the SEP, you can either re-apply on healthcare.gov and get a new subsidy going forward, or at your 2022 tax filing for 2021, get additional credits for what you overpaid at that time.

 

Sunday, June 14, 2020

3 PRIMARY REASONS TO VOTE NO ON SQ#802!

Weekly Opinion Editorial

 

SQ#802 IS BAD FOR OKLAHOMA!

by Steve Fair

 

     State Question #802 will be on the June 30th primary ballot.  It is an initiative petition supported by those who want to expand Medicaid program for low income Oklahomans whose income does not exceed 133% of the federal poverty level.  If passed, it would become a part of the state Constitution. 

     Oklahomans Decide Healthcare is the group supporting SQ #802.  They contend that expansion of Medicaid will make Oklahoma families heathier and the economy stronger.  The Oklahoma Council of Public Affairs(OCPA) opposes SQ #802, partly because federal bureaucrats set the federal poverty level.  Governor Kevin Stitt opposes SQ #802 saying, “If SQ#802 passes, our state agencies will experience deep cuts because the ballot measure offers no mechanism to pay for it.”  Four observations:

     First, health care funding should not become part of the state Constitution.  That is the primary fishhook in SQ #802. There are those who support expansion of Medicaid who oppose having it into the state Constitution.  Having it in the Constitution forces the legislature to fund it, no matter what.  Bad idea.   

     Second, Oklahoma taxpayers can’t afford Medicaid expansion.  With the downturn in the oil and gas industry, gross revenue tax revenue is down.  Unemployment is up in the Sooner state and couple that with the pandemic, it is certain that other sources of revenue will be down as well.  Oklahomans Decide is wrong- putting more tax burden on hurting, struggling people doesn’t strength the economy, it cripples it.

     Third, the federal matching funds are not guaranteed to be there forever.  OCPA says,  "Oklahoma would be obligated to provide medical assistance to adults at or below 138% of the federal poverty level regardless of whether Congress continues to pay a large portion of the costs. Congress would dictate how much money actually leaves Oklahoma’s treasury.”   Congress currently appropriates the federal matching funds for Medicaid, but they can quit at any time.  With SQ #802 in the Oklahoma state Constitution, Oklahoma taxpayers will have to pick up the slack if Congress quit funding the expansion

     Fourth, it is still unclear how many are eligible and will sign up if Medicaid is expanded.  State health officials estimate that 220,000 will be eligible and 180,000 would sign up.  In several states, the actual numbers who signed up for Medicaid expansion was much higher than the estimates and created funding issues. 

     According to the Centers for Medicare and Medicaid Services (CMS), healthcare spending in the US is estimated to grow by 5.4% annually for the next eight to ten years.  Projections indicate health care spending will cost an estimated $6.2 trillion by 2028.  Much of that is due to the aging population in the US. Healthcare will continue to be a topic of discussion for the foreseeable future and Medicaid expansion may be necessary in Oklahoma, but SQ #802 is not the way to do it.

    Vote no on SQ #802 for the following reasons: (1) Healthcare funding should not be a part of the state Constitution, (2) It is an unfunded mandate.  It doesn’t increase taxes to pay for the expansion- it just mandates it, (3) Oklahoma taxpayers simply can’t afford it.   

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May 29, 2020

Oklahoma scraps plan to expand Medicaid on July 1

OKLAHOMA CITY (AP) — Oklahoma Gov. Kevin Stitt’s administration is scrapping a plan to expand Medicaid on July 1, citing a lack of state funding.  The state’s Medicaid Director Melody Anthony notified the U.S. Department of Health and Human Services in a letter Thursday that the state was withdrawing its proposal.  The Stitt administration pushed for the expansion in March, but after the Legislature narrowly passed bills to help pay for the state’s share, including one that increased a fee that hospitals pay, Stitt vetoed them.

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Stitt said in his veto message that while he appreciated the Legislature’s willingness to help fund his expansion plan, he worried that the rising unemployment rate would dramatically increase the number of people who qualified for Medicaid.

The governor is still pursuing a block-grant-style Medicaid expansion offered by the Trump administration, dubbed the Healthy Adult Opportunity waiver, that would give states more control over Medicaid in exchange for a limit on how much the federal government kicks in. But that proposal wouldn’t take effect until 2021.

Meanwhile, Oklahoma voters will decide on June 30 whether to fully expand Medicaid when they vote on State Question 802. That proposal, if approved, would also take effect next year and would supersede the governor’s plan.

A Medicaid expansion would extend health insurance to low-income adults who earn up to 133% of the federal poverty level, or $16,970 for an individual and $34,846 for a family of four. The Oklahoma Health Care Authority, the state’s Medicaid agency, initially estimated about 220,000 Oklahomans would immediately qualify, at a total cost of about $1.24 billion annually. The federal government would cover about $1.1 billion in annual costs with the state responsible for about $150 million each year.

But with skyrocketing unemployment in Oklahoma as a result of crashing energy prices and an economic slowdown due to the coronavirus pandemic, the number of people who qualify for Medicaid, and the cost of the program, could be much higher.

 

March 16, 2020

 Employment and Labor Client Alert 

Employment & Labor Client Alert
The Families First Coronavirus Response Act:  
Employers with 500 Employees or Less Must Offer FMLA and Paid Leave for COVID-19, if Passed
By: Paula Williams, Chris Thrutchley, and James Scears
March 15, 2020

On March 14, the U.S. House passed the Families First Coronavirus Response Act by a vote of 363 to 40. It requires employers with 500 or fewer employees to grant FMLA leave due to COVID-19 and up to two weeks of paid sick leave for absences related to COVID-19. To help employers pay for it, the Act grants employers refundable tax credits. The Act also expands unemployment benefits due to COVID-19. It will sunset at the end of 2020. 

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President Trump called it “good teamwork” between Democrats and Republicans, signaling support for the bipartisan bill. Early this next week, the Senate will take up its version and, if passed in a different form, the Act will move through reconciliation.   This Client Alert summarizes key details of the version just passed by the House to help employers prepare for what’s likely to come. GableGotwals' Employment & Labor team is closely monitoring the developments. As soon as President Trump signs a final version, we will notify employers. We will also have policy templates available for employers to use for compliance with the final version of the Act. Employers should stay alert as we monitor updates and changes closely.   Please consider forwarding this Client Alert to anyone you know who handles HR for smaller employers that may be impacted by this Act. 

 

Emergency Family and Medical Leave Expansion Act
The Act includes the Emergency Family and Medical Leave Expansion Act. The FMLA Expansion extends the FMLA to expand to all employers under 500 employees (with some limited exceptions). Employees who have worked for the employer at least 30 days may take up to 12 weeks of protected FMLA leave for any of the following reasons related to COVID-19: 

•    Quarantine, whether required or recommended based on exposure or symptoms; 
•    Caregiving for an at-risk family member in required or recommended quarantine; or 
•    Caregiving for an employee’s child whose place of care or school has closed due to coronavirus. 

The first two weeks may be unpaid unless the employee chooses to use paid time off benefits. An employer cannot force the use of paid time off benefits. After two weeks, employers must pay for the FMLA leave at no less than two-thirds of the employee’s usual rate of pay. After the leave, employers must restore the employee to the same or equivalent position (with some exceptions for employers with fewer than 25 employees). The Secretary of Labor may issue regulations exempting employers with less than 50 employees when the “requirements would jeopardize the viability of the business as a going concern.” 

Like the FMLA, the FMLA Expansion prohibits retaliation against an employee who either requests to use or uses FMLA-COVID-19 leave. Under the FMLA, not only may an employer be held liable for violations, but also individual managers and supervisors face risk of personal liability. 

 

Emergency Paid Sick Leave Act
The Act also includes the Emergency Paid Sick Leave Act. The Sick Leave Act requires employers to provide employees (no matter how long they’ve been employed) up to two weeks of paid emergency sick leave in order to: 

•    Self-isolate because of a coronavirus diagnosis; 
•    Obtain a diagnosis when experiencing symptoms; 
•    Self-quarantine based on a public official or healthcare provider recommendation due to exposure or symptoms; 
•    Care for a family member who is self-isolating or experiencing symptoms; or 
•    Care for a child if the school or place of care has closed due to coronavirus. 

Emergency sick leave is in addition to any other sick leave already provided by the employer if the employer’s leave was in place before the date of enactment of the Act. The Act prohibits employers from: 

•    Changing leave policies to avoid the Act; 
•    Requiring employees to use other paid leave before using emergency sick leave; or
•    Requiring employees to find a replacement to cover for them while using emergency sick leave.

Emergency sick leave is capped at 80 hours for a full-time employee. Part-time employees may take the typical number of hours they work in an average two-week period. Unused emergency sick leave does not carry over into 2021.

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Tax Credits for Emergency Leave and FMLA Leave
Employers who pay for emergency sick leave or FMLA-COVID-19 leave will be allowed refundable tax credits generally equal to 100% of the amounts required to be paid during each calendar quarter (with certain caps and limitations on the credits available depending on the type of leave being paid and the reason the employee takes leave). These refundable tax credits are allowed against the employer portion of Social Security taxes. Self-employed individuals separately qualify for similar refundable tax credits.

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Best Practices to Manage Coronavirus in the Workplace
As the Act unfolds, GableGotwals is committed to helping employers address the many nuances and legal considerations that accompany coronavirus in the workplace. We are developing policy templates for employers who already have an FMLA policy, employers who do not have any FMLA policy but will need to adopt one, and for all employers who will need an emergency sick leave policy to comply with the final version of the Act once it takes effect. We will also provide information for a webinar soon. In the meantime, employers should be doing following now: 

•    Review your current leave-related policies and be prepared to consult counsel quickly to update your policies if needed; 
•    Consider restricting non-essential business travel; 
•    Require that employees comply with CDC quarantine guidance when returning from personal travel to a high-risk area; 
•    Send employees home who exhibit coronavirus symptoms, and require they not return until they are 24-hours symptoms free; 
•    Do not ask employees questions likely to elicit information about a disability unless job related and consistent with business necessity; 
•    Instruct managers and supervisors to promptly notify HR in confidence of any employee who says anything about having a physical or mental impairment so HR can coordinate with in-house or outside counsel to ensure any potential FMLA or ADA issues are handled in the right way; 
•    Make temporary, emergency modifications to remote-work policies; 
•    Be aware of employees with disabilities, such as those who are immuno-compromised, who may require accommodation; 
•    Keep all medical information separate and strictly confidential; and 
•    Request that employees self-report known exposure to the coronavirus. 

If you would like to be added to Gable's Employment & Labor mailing list, please contact Melissa Pasha.

Paula M. Williams
405-568-3302
pwilliams@gablelaw.com
   
Chris S. Thrutchley
918-595-4810
cthrutchley@gablelaw.com
   
James M. Scears
918-595-4879
jscears@gablelaw.com

 

 

This article is provided for educational and informational purposes only and does not contain legal advice or create an attorney-client relationship. The information provided should not be taken as an indication of future legal results; any information provided should not be acted upon without consulting legal counsel.