Incoming CEO for Oklahoma Medicaid agency faces challenges
BY WAYNE GREENE World Senior Writer
Sunday, January 20, 2013
1/20/13 at 8:01 AM
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OKLAHOMA CITY - As he talks about running Oklahoma's third most expensive agency and leading the state through the challenging future of health-care reform, Nico Gomez tosses a baseball from hand to hand.
Gomez, 41, has been tapped to be the next CEO of the $5 billion-a-year Oklahoma Health Care Authority - Oklahoma's Medicaid agency - but there was a time, just out of high school, when his job was umpiring Little League baseball games.
"It's a great metaphor for life," Gomez says. "It taught me respect for people who have to make decisions.
"As an umpire, you've got to be in the right place to get the best view to make the best decision, and no matter what decision you make ... there's going to be people who aren't very happy with you."
Gomez, currently the agency's deputy director, takes the field as the state's top Medicaid bureaucrat on Feb. 1, and there are sure to be plenty of people ready to question his calls.
In the next year, the federal health law - the Affordable Care Act or Obamacare as it is known - gradually takes effect.
On Oct. 1, the law's health insurance exchange will start enrolling people in Medicaid and private federally subsidized health insurance plans. While state government has resisted the exchange process, the authority must act as a key intermediary with it.
On Jan. 1, coverage mandates and taxes take full effect, which will likely drive more people to the exchange and into the Medicaid and private health market.
At any point, the state could opt to take part in the federal law's offer to expand vastly the number of people who are eligible for Medicaid, further stressing the authority's systems.
Alternatively, the state could come up with a plan of its own - possibly based in the authority's Insure Oklahoma program - creating more work potentially in a very short time period for Gomez's agency.
Whatever the next months bring, Gomez said he is confident that the health care authority is ready to deal with the issues efficiently and with great respect for its clients and the taxpayers.
"By far, this is the biggest policy change in health care probably since Medicaid was created in 1965, but in that I think there's also opportunity," Gomez said.
At the same time that the state and the federal governments are realigning the way health services are financed, there is a chance to recruit and train a new generation of medical professionals, strengthen family units and actually improve the overall health of the people of Oklahoma, he said.
The exact means of reaching those ends may not be clear now, but Gomez said that's part of the challenge.
"I think one of the things that this agency takes pride in is we really have taken a 'yes, if' approach to operations," Gomez said. "We don't like to be in a position to say things are impossible."
Sen. Kim David, chairwoman of the Senate Appropriations Subcommittee on Health and Human Services, said Gomez was a natural choice for the agency's leadership because of that attitude.
"I'm very excited to have Nico at the health care authority," David said. "We work very well together."
Gomez is an excellent communicator and maintains an open mind to outside ideas, she said. "Because of his attitude, I have confidence in him when he tells me something."
Gomez says he never intended to become a Medicaid leader.
He was born in Altus, grew up in Oklahoma City and earned a bachelor's degree in journalism at the University of Oklahoma. He lived a middle-class childhood, free of anxiety about health-care financing. His father ran a nonprofit agency that aided migrant workers and his mother worked at the General Motors plant.
"There really is no Medicaid backstory on me. I didn't go to the School of Journalism thinking one day I would be a Medicaid professional, but here I am," he said.
He got there by being a careful, thorough communicator, who doesn't take himself so seriously that he can't be seen wearing a Mickey Mouse watch or dressing up like Elvis for an agency charity event.
Gomez started out as a public relations man for the state highway department, then moved to a better opportunity at the health care agency in 2000. He took on responsibilities of legislative liaison in 2004 and became the agency's deputy CEO in 2008.
As CEO he will earn $152,000 a year, plus benefits.
Despite months of public debate about health-care policy, there are some misunderstandings about Medicaid and the health care authority, Gomez said.
"I think there's a misperception that if you're poor, you're automatically qualified for Medicaid," Gomez said.
That's not true. In Oklahoma, you have to be poor to qualify for Medicaid and you have to be a U.S. citizen and you have to fall into certain categories: children, pregnant women, the disabled and the elderly.
Most of the people in Oklahoma's Medicaid program are under the age of 18. Most of its money is spent on people over the age of 65.
A million Oklahomans a year will go through the program.
Another misunderstanding is that Medicaid is inefficient, Gomez said.
"There is a misperception that Medicaid is broken, and I think that stems from some national issues that are going on," he said. "We take a lot of pride in making sure that we're accountable in how we spend money."
The authority has one of the nation's lowest error rates among the states, according to federal watchdogs. State and federal audits find very few - some 1.24 percent - of the state's Medicaid claims aren't for legitimate, medically necessary services.
The state also maintains a low administrative cost for Medicaid, about 5 percent, with half of that going to other state agencies that have a piece of the Medicaid system and the authority's share largely used to finance a contract with a private vendor who pays the claims of medical providers.
"I would put our administrative costs and our payment efficiency up against any private health-care carrier in the country," Gomez said.
That efficiency can't come at the cost of forgetting that the agency's job is to help people - including some of the most physically and financially challenged residents in the state.
"The 500 people who work here come to work every day trying to make life better for someone else. That gives a juice no chemical can replicate," Gomez said. "No matter what is decided at the state or federal level, our job is pretty monumental as it is, and that is to take care of people who are in the program today."
About the Oklahoma Health Care Authority
Job: The state's Medicaid administrator.
Employees: About 500.
Annual budget: More than $5 billion.
Finances: Roughly one-third state funding and two-thirds federal funding. Only common education and higher eduction receive larger state appropriations.
Clients: More than 1 million in any 12-month period.
Key tasks: Assuring client access to medical providers, managing client health care, auditing claims and making payments.
Original Print Headline: Incoming CEO faces challenges
Wayne Greene 918-581-8308
Nico Gomez: His stint as a Little League umpire taught him about making decisions and dealing with those who disagree.