Oklahoma Medicaid Director Traylor Rains is leaving the agency at the end of the month.
Oklahoma Health Care Authority CEO Ellen Buettner shared with authority board members during their Wednesday meeting that Rains' predecessor, Melody Anthony, will serve as the interim state Medicaid director.
"[We're] happy to have someone that already understands our program. She is in on the managed care side as well," Buettner said during the meeting. "So we're really grateful that she's volunteered to come back and serve while we make sure we get the right person to fill the big shoes that Traylor leaves."
An OHCA spokesperson told StateImpact Rains is taking a job with Deloitte, and his last day will be at the end of the month.
Rains was announced as the agency's state Medicaid director in March 2022. He had served as the senior director of policy and provider regulation at the Department of Mental Health and Substance Abuse Services, the chief operating officer for the Department of Human Services and OHCA's deputy state Medicaid director.
His tenure spanned the Medicaid unwinding - an eligibility process states resumed after a pandemic pause - and Oklahoma's transition to managed care, or SoonerSelect. OHCA went from paying providers directly to paying private companies to coordinate some enrollees' care.
Rains also provided an update to OHCA board members on SoonerSelect during its January meeting, sharing data on enrollment and utilization rates.
As of December 2024, there were 624,000 enrolled members. About 55% of those members were utilizing services. Rains said the utilization rate has fluctuated between 50-55%.
"Compared with previous years of the same population, that's about on par," Rains said. "We actually see an average of around 50% pre-managed care."
Rains also highlighted SoonerSelect recipients' emergency room utilization.
Rains said annualizing emergency department visits over last year would come out to approximately 265,000 visits.
"We are in a really bad flu and RSV and other infectious disease season right now. So I wouldn't be surprised if we see an uptick in that over the next couple of months," Rains said.
OHCA also shared two new grant opportunities it will be participating in.
The first is the Transforming Maternal Health Grant. Oklahoma received an award from the Centers for Medicare and Medicaid Services alongside 13 states and the District of Columbia to participate in the Transforming Maternal Health Model.
It will support participating Medicaid agencies in developing a "whole-person approach" to pregnancy, childbirth and postpartum care, addressing physical and mental health, and social needs.
The agency requested almost $17 million over 10 years. The planning years for the grant will span this year through 2027, and implementation will occur from 2028-2034.
Rains said it will work with community partners, including the Oklahoma Perinatal Quality Improvement Collaborative and the Oklahoma Birth Equity Initiative.
"Over the last several years, we've invested a lot of resources in this space through raising the [federal poverty level] for pregnant moms, expanding the postpartum period, adding additional services," Rains said. "And so we thought that the time is right to really utilize this investment, if awarded."
Rains also highlighted the Innovation in Behavioral Health Model Grant. Oklahoma was one of four states to receive it. The total award will include $1.25 million over the next 10 years, and OHCA is partnering with the Oklahoma Department for Mental Health and Substance Abuse Services.
The model focuses on improving care quality and outcomes for adults enrolled in Medicaid and Medicare with moderate to severe mental health conditions and substance use disorder.
"Essentially, it's figuring out innovative ways to use technology to connect people who have those behavioral health needs," Buettner said.