Medicaid programs in Oklahoma paid out $211 million less in May than in April, at least partly because people avoided the health care system, according to state officials.

Expenditures in May were also nearly $100 million less than they were in May 2019. The Oklahoma Health Care Authority, which oversees the health insurance program for low-income Oklahomans, said the steep drop resulted from multiple factors.

The decrease in Medicaid spending came as Gov. Kevin Stitt vetoed a temporary hike in a state hospital fee to fund his Medicaid expansion proposal, Sooner Care 2.0. The fee hike would have raised an estimated $134 million in a year.

In his veto message, the governor said the fee increase would not have fully funded the expansion, in part because the economic conditions created by the novel coronavirus would mean even more people would need the public health insurance.

The governor’s office also withdrew the proposal filed with the federal government to tailor an expansion plan. Oklahoma is one of 14 states that has not used Affordable Care Act funding to expand its Medicaid program.

In a statement this week, a Stitt spokesman said recent savings in state Medicaid programs would not have helped fund the governor’s plan, even though some carryover is expected in the fiscal year that begins July 1.

“The governor has said from the beginning that funding for SoonerCare 2.0 needs to be sufficient and recurring,” the spokesman said.

“Any cost differences in recent months are likely the result of deferred care during the COVID-19 pandemic and it would not be fiscally prudent to use those funds for other purposes like expansion.”

Voters will have the opportunity on June 30 to approve a statewide ballot question to expand Medicaid to people with higher incomes than currently qualify. Should it pass, the question would become part of the state constitution, requiring the Legislature and Stitt to agree on a funding mechanism.

The Oklahoman requested information about state Medicaid expenditures for March, April and May of 2020 and the same months of 2019 to determine whether stay-at-home orders and fear of the novel coronavirus had affected the insurance program.

Oklahoma City hospital leaders have said their emergency room visits and other care had dropped significantly because people were afraid to be exposed to the virus.

Health Care Authority figures show that March and April of 2020 saw higher expenditures than March and April of 2019.

But expenditures for May 2020, were significantly lower than any of the other months. According to the Health Care Authority, all Medicaid programs paid out $367.7 million in May. That was down from $579.6 million in April. And it was down from $462.6 million in May 2029. May was one of only two months examined in which expenditures fell below $500 million.

The expenditures don’t only reflect health care services rendered in a particular month, since billing lags the physician or pharmacy visits. The expenditures reflect the month in which bills were paid.

A spokeswoman for the Health Care Authority said month-to-month comparisons were difficult. She noted that the agency pays bills weekly and that some months have more payment days than others. May of 2020 had only four, while April 2020 and May 2019 had five, she said. The agency also must pay $100 million or more every quarter into the Supplemental Hospital Offset Payment Program, and a payment was made in May.

Rate increases and season fluctuations also have to be considered, she said.

“All of that said, we have seen expenditure declines that may be attributed to decreased utilization related to COVID,” she said.

“However, we anticipate that the majority of this utilization decline is deferred and will be incurred in the future, likely in the next fiscal year.”

The state’s next fiscal year begins July 1.

The spokeswoman said there would likely be carryover from people deferring care and enhanced federal funds.

She said that carryover “will be utilized to cover the cost related to projected increases in enrollment due to unemployment, as well as the cost of deferred services.”

Written by Chris Casteel of the Oklahoman