Medicaid Expansion Offers Richer Benefits to 200,000 Oregonians

The public has 30 days to comment before the Oregon Heath Policy Board makes a decision
The Lund Report

 

December 13, 2012 -- The 200,000 Oregonians expected to qualify for Medicaid coverage in 2014 will receive more robust benefits if the Oregon Health Policy Board approves a recommendation from the Medicaid Advisory Committee.

Now many low-income adults lack the dental, rehabilitative and optical care required by the Affordable Care Act, which expands Medicaid coverage to 133% of the poverty line. Those newcomers would receive care in the Oregon Health Plan Plus that’s already offered to children, pregnant women and people with certain disabilities.

“The Oregon Health Plan Plus is slightly richer than the average commercial plan,” said Rhonda Busek, who chairs the advisory committee, adding that people wouldn’t have to pay deductibles or co-payments to access care.

Up until 2017, the federal government will absorb 100% of the cost for the expansion.

“We have an incredible opportunity in this state to save lives,” Dr. Bruce Goldberg, administrator of the Oregon Health Authority, told the Oregon Health Policy Board earlier this week.

The public has 30 days to comment before the board makes its decision on the Medicaid expansion, which comes amid a major overhaul of the Oregon Health Plan into coordinated care organizations that integrate physical, behavioral and dental health under one delivery system using a global budget.

The expansion of Medicaid and the transformation into CCOs have come against a backdrop of fiscal decisions in Washington, D.C. that could include narrowing the budget deficit by cutting federal healthcare services.

“Time is not on our side,” Goldberg said. “We need to blaze a path for the country because we don’t want to resort to those ways.”

The Health Policy Board also hosted a public forum, hearing from people concerned about the rollout of CCOs.

Several people insisted state officials weren’t doing enough to communicate the details about CCOs in plain English, let alone other languages.

Heather Hack, a midwife, spoke about the need to include midwifery services in CCOs given the high number of pregnant women on the Oregon Health Plan. “We provide care to healthy, low-risk women,” she said. “The CCO model seems to fit seamlessly into our own model.”

Social worker Steve Arnold worried that the consolidation of mental health benefits would drastically scale back such care. “It’s critical that the number of hours of conversation about mental healthcare and addiction not be reduced.”

And, dietician Nancy Becker wanted assurances that people had access to registered dietician service at all levels. “My concern is that the nutrition services are getting sandwiched by doctors on one end and community healthcare workers at the other.”

Dr. Kristen Dillon, a board member of the PacificSource- Columbia Gorge CCO, said most healthcare providers in Hood River and Wasco counties meet at the same table. But it’s been tricky implementing the system in rural areas where residents don’t necessarily respect county boundaries, specifically those in Sherman County.

“Many of them have traveled west for care and now they’re being directed east,” she said.

The small size of the Medicaid pool also inhibits the work of the CCOs, she added. “It’s really hard to develop a system just for those patients while leaving out the other 85 percent of the community.”

Since the CCOs got under way, more than 600,000 Oregon Health Plan members have been transitioned into 15 organizations, Goldberg said, while the state’s been torn between moving too quickly and not quickly enough to deal with everyone’s concerns.

“The transformation is based on local control and local accountability and with that comes a promise of local flexibility,” he said.

Several CCOs have been particularly innovative, he added, such as Trillium Community Health Plan in Lane County, which sets aside $10 per patient. Those dollars will enable the public health department to hire an epidemiologist and two health analysts to develop evidence-based tobacco prevention measures.

“I go around the country, and I see a lot of confusion,” Goldberg said. “In Oregon, I see people who are engaged, they’re excited, they’re enthusiastic.”

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