OKLAHOMA CITY — In addition to his normal job treating patients in an eastern Oklahoma emergency room, Dr. Doug Cox, on his own time, drives 20 miles to care for people with low incomes who live in a nursing home.

As Oklahoma’s Health Care Authority weighs cutting Medicaid reimbursements to doctors and other heath care professionals by as much as 25 percent, Cox isn’t sure he’ll continue making the trip.

“As much as I love caring for our seniors, I can’t afford to do it at a loss,” he said, noting that doctors have bills to pay, too. “So I may be one of the doctors that drop out” of the Medicaid program, he said.

Cox, also a Republican lawmaker from Grove, is among thousands of doctors and others who received a letter from the State Medical Association last week urging them to quit the state’s largest insurance program should the 25 percent cut take effect in June, as scheduled.

The association acknowledged that doctors dropping Medicaid will create “an access-to-care crisis for rural residents, vulnerable seniors, the disabled and nearly 60 percent of babies born under Medicaid.”

But the cut, it noted, will be “unsustainable for most medical practices.”

More than 800,000 Oklahomans are covered by the state’s Medicaid plan. The federal program, which provides health insurance for the poor, is administered by the states.

In addition to doctors, cutting Medicaid payments will affect nursing homes, pharmacies, dentists, companies that rent medical equipment such as wheelchairs and oxygen tanks, as well as home health services.

If lawmakers can’t figure out how to shore up the state’s Medicaid plan while maintaining its network of doctors and providers, one expert said Oklahoma could jeopardize billions of dollars in funding that cover nearly 60 percent of its Medicaid costs.

Federal law requires that Medicaid patients have equal access to health care as patients with private insurance and Medicare, said MaryBeth Musumeci, associate director of the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured.

If a state doesn’t comply, the federal Centers for Medicare and Medicaid Services can withhold the state’s funding. In Oklahoma, that amounted to more than $3.1 billion last year.

Musumeci wasn’t sure if the agency has ever withheld funding, and its spokespeople did not respond to the question.

In an email, Oklahoma’s Health Care Authority said it will address concerns about equal access “at the appropriate time.” It said it does not have data on patient access, but the state has worked with federal regulators during rate reductions over the last two years.

Throughout the state, Cox said many doctors, particularly specialists, may abandon the insurance plan if the latest round of cuts are implemented.

The state proposes setting its reimbursement about 10 percent lower than most providers can afford and still break even, he said.

Officials with the Health Care Authority said it’s coincidence that these cuts come a month before more stringent federal rules take effect, requiring states that reduce Medicaid reimbursements to first conduct a review showing that patients have sufficient access to care and to monitor future access.

Those standards were implemented after high-profile cases involving California and Idaho, which landed before the U.S. Supreme Court, Musumeci said. In those cases, doctors and other providers complained that reimbursements were slashed too much, she said. In California, providers faced a 10 percent reduction.

Cox predicted bleak conditions if lawmakers cannot find a way to shore up Medicaid reimbursement amid a $1.3 billion budget shortfall.

“We’re going to go back to the days of old, when a primary care doctor would have to call around and almost beg and plead for a specialist to see a Medicaid referral, because in their defense, the payment rate was so low it was less than their overhead,” he said.

“You can only see so many people at a loss and stay in business,” he added.

Contributing to the problem, he said, is the number of people on Oklahoma’s Medicaid rolls. Most states cut off enrollment for those who make 133 percent more than the poverty line. In Oklahoma, the threshold is about 185 percent — at least until October 2019 — a condition of accepting federal stimulus money in 2010, Cox said.

“It’s just to the point where we can’t afford that many,” he said.

At the end of last year, nearly 72 million people nationally were on Medicaid.

Cox said a $1.50 per pack tax on cigarettes could help buttress the Medicaid system. Gov. Mary Fallin had proposed a hike in cigarette taxes that would raise about $188 million a year.

But Cox, who authored the legislation to split the proceeds between teachers and health care, said he’s now willing to use all of the revenue for Medicaid.

The proposal has not gained traction among his colleagues, he noted.

Janelle Stecklein covers the Oklahoma Statehouse for CNHI’s newspapers and websites. Reach her at jstecklein@cnhi.com.