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ENGR. H. A. to ENGR. S. B. NO. 202 Page 1
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ENGROSSED HOUSE AMENDMENT
TO
ENGROSSED SENATE BILL NO. 202 By: Daniels of the Senate
and
Hill of the House
An Act relating to the state Medicaid program;
amending 56 O.S. 2021, Section 1010.1, as last
amended by Section 2, Chapter 133, O.S.L. 2024 (56
O.S. Supp. 2024, Section 1010.1), which relates to
premium assistance program; modifying eligibility
requirements for self-funded or self-insured health
care plan to participate in premium assistance
program; conforming language; updating statutory
language; updating statutory references; and
declaring an emergency.
AMENDMENT NO. 1. Page 1, lines 6 through 10 1/2, strike the title
to read:
"[ state Medicaid program - premium assistance
program - eligibility requirements - self-funded or
self-insured health care plan –
emergency ]"
ENGR. H. A. to ENGR. S. B. NO. 202 Page 2
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Passed the House of Representatives the 1st day of May, 2025.
Presiding Officer of the House of
Representatives
Passed the Senate the ____ day of __________, 2025.
Presiding Officer of the Senate
ENGR. S. B. NO. 202 Page 1
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ENGROSSED SENATE
BILL NO. 202 By: Daniels of the Senate
and
Hill of the House
An Act relating to the state Medicaid program;
amending 56 O.S. 2021, Section 1010.1, as last
amended by Section 2, Chapter 133, O.S.L. 2024 (56
O.S. Supp. 2024, Section 1010.1), which relates to
premium assistance program; modifying eligibility
requirements for self-funded or self-insured health
care plan to participate in premium assistance
program; conforming language; updating statutory
language; updating statutory references; and
declaring an emergency.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY 56 O.S. 2021, Section 1010.1, as
last amended by Section 2, Chapter 133, O.S.L. 2024 (56 O.S. Supp.
2024, Section 1010.1), is amended to read as follows:
Section 1010.1. 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
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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 state Medicaid Program 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
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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
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
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(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 of
1986, as amended, 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 of 1986, as amended.
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.
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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,
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 state Medicaid Program 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
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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 A self-
funded or self-insured health care plan as a participating health
care plan shall be eligible to participate in the premium assistance
program created under this section if:
1. The self-funded or self-insured health care plan meets at
least one of the following conditions:
a. the plan is utilized by an employer that was
participating in the premium assistance program as of
May 1, 2024, or
b. the plan is owned and operated by an interlocal self-
funded public trust formed under the Oklahoma Statutes
and comprised of local government employers;
ENGR. S. B. NO. 202 Page 7
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2. The self-funded or self-insured health care plan is:
a. recognized by the Insurance Department under Section
6012 of Title 36 of the Oklahoma Statutes, if the plan
meets the conditions of subparagraph a of paragraph 1
of this subsection, or
b. under the oversight of the Office of the Attorney
General, if the plan meets the conditions of
subparagraph b of paragraph 1 of this subsection;
2. 3. 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. 4. 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. 5. The self-funded or self-insured health care plan assesses
a monthly premium on members and maintains a rate schedule for
provider employer reimbursement;
5. 6. 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 or the Office of the Attorney General, as
applicable, that the self-funded or self-insured health care plan
meets such actuarial standards; and
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6. 7. The Authority receives the necessary federal approval for
self-funded or self-insured health care plans to participate in the
premium assistance program.
SECTION 2. It being immediately necessary for the preservation
of the public peace, health or safety, an emergency is hereby
declared to exist, by reason whereof this act shall take effect and
be in full force from and after its passage and approval.
Passed the Senate the 12th day of March, 2025.
Presiding Officer of the Senate
Passed the House of Representatives the ____ day of __________,
2025.
Presiding Officer of the House
of Representatives