Concerns over the program providing care for 1.4 million low-income Oregonians are the worst he’s seen since joining the Legislature more than a decade ago, said Rep. Rob Nosse, who chairs the House Committee on Behavioral Health and Health Care.
Some of the organizations paid with state and federal funds to oversee and direct care in the Medicaid-funded Oregon Health Plan have experienced massive losses and are now considering pulling out of the program entirely, as The Lund Report first reported last week.
They have until next month, Sept. 18, to officially notify the state of their plans, and Nosse said the idea of providing care without the groups, known as coordinated care organizations, would be bad news for patients and providers. “It’s not been contemplated in 20 years,” he told The Lund Report.
State health officials charged with maintaining the program, as well as Gov. Tina Kotek’s office, have declined to discuss the situation citing ongoing negotiations over reimbursement rates.
Nosse, one of the Legislature’s two point people when it comes to the care organizations, said the current proposed rates of 6.8% — let alone the much smaller rate, 3.4%, allocated by lawmakers in the current budget — won’t cover what the care organizations say are their costs.
“The people at OHA have assured me that they believe the CCOs. So, yeah, nobody's thinking anybody's making this up or exaggerating,” he said.
“They're taking it seriously, so they're giving more time for everybody to evaluate. They're asking for more information. They're giving a longer time for the CCOs to sign the contract. So I feel like everybody's doing what they're supposed to be doing as we evaluate how we're going to handle this.”
The Oregon Health Authority has spearheaded a push to eliminate a cost-control program favored by the care organizations. Meanwhile, a bill aimed at reducing costs, eliminating redundancies and trimming the administrative burden faced by the care organizations and other providers in behavioral health garnered a price tag from the agency, likely contributing to its death.
Now the agency finds itself having to consider other changes to reduce costs. It’s unclear what changes the health authority will land on, if any, in the short term. But Nosse said some changes will have to happen, eventually.
“In the long run, we're going to look at all that stuff, because we're going to have to make changes. We will not be able to afford the style of Medicaid benefit we currently have — not by a long shot.”
Comments
I couldn't sleep one night…
I couldn't sleep one night many years ago, so was channel searching and came across a PBC channel where Michael Gorbachev was being interviewed and was asked the question why the Soviet Union failed and his answer surprised me, he said it failed for it collapsed under the weight of its own bureaucracy where there were so many rules and regulations that nothing got done. Has the OHP plan reached this point, collapsing under the weight of the bureaucracy?
Mike Shirtcliff DMD
It's interesting that Oregon's version of an accountable care organization called a coordinated care organization which puts a group of providers, physical, behavioral and oral health at risk for almost all Medicaid recipients in Oregon for certain outcomes is running out of money. Is it because the state lost vision and is taking away processes that help the CCO manage the money as stated in this article and the legislature mandating more to be done for the same money? Such as the social determinants of health coverage of housing, food insecurity, and air conditioners and the expansion of behavioral health requiring all providers whether in a CCO network or not and allowing them to bill fee for service. If provider group or company that is not at risk like behavioral health and things like pharmacy and specialty care put the entire system at risk. If you require 85% to go for care, you limit growth to 3.4% and you require those at risk to keep doing like we always have like mandating nurse to patient ratios, what has to be covered for adults in dentistry etc. The question I have to ask is are we about doing the same thing over and over again expecting different results or are we about the health of the population? Everyone pretty much knows that the end of disease system in America is expensive and does not promote health, it promotes repair. It seems few have the backbone to do what is needed and keep requiring more and more for a little bit more and it is easier to just ask for more money because when those in the system ask for some support against the voters is it turned down. I know for a fact that the population oral health could be done for at a minimum 10% less than the current rates and produce better oral and overall health, but the expectations of what is required would have to change and since all who legislate and administer the programs and the dental profession itself all have an inherent bias of what dentistry is like, nothing will change except more people will suffer, money will be mis-allocated and wasted and little kids like the 4 year old who is brain dead from dental anesthesia will continue to be at risk. Since oral health portion of the CCO budget is a little less than 5%, a 10% savings would only be around $35-40 million and out of the total budget this is what Barny Speight once called "decimal dust". Don't get me wrong, I am not picking on anyone group, just commenting on what I have been observing from my experience of having been involved since 1994.
Mike Shirtcliff DMD