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Feds Approve $2 Billion, Enrollment Changes For Oregon Health Plan

Children entering the program will remain enrolled until their 6th birthday to improve health, access and avoid the paperwork failures that often lead to disenrollment.
September 28, 2022

Federal officials have approved sending $2 billion in new spending to Oregon in connection with changes to the Oregon Health Plan, the state's program of free care for low-income people.

The changes, announced Wednesday, include continuous coverage for kids under 6 years old and two-year enrollment periods for people above 6 — both intended to lessen the loss of coverage associated with the paperwork hurdles of yearly eligibility checks.

Of the new funding, $1.1 billion will be used to support additional flexibility in spending of state and federal Medicaid funds on services affecting health such as food, housing and climate-related programs.

Gov. Kate Brown hailed the federal approval in a 7 a.m. press conference with federal officials. “I am thrilled,” she said in response to a question from The Lund Report. “Keeping young children continuously enrolled in Medicaid up to the age of six to prevent gaps in coverage, regardless of changes in their financial circumstances is a paradigm shift. We're going to be the first state in the country to do this.”

The new emphasis on health-related spending, including services not considered traditional health care, drew praise from advocates invited to an Oregon Health Authority later on Wednesday. “While we know the waiver will not enable us to serve everyone in need or completely solve hunger or diet related disease, it will help health care providers who are committed to holistic health and equity to advance food justice,” said Sarah Sullivan, executive director of the Gorge Grown Food Network.

The federal decision, called a “waiver” because it allows the state to modify standard Medicaid rules, also entailed approval of the state’s application to renew the Oregon Health Plan for the next five years. Currently, 1.4 million adults and children receive coverage through the plan, or 1 in 3 Oregonians.

 Mercedes Elizalde, public policy director for Central City Concern, said the new flexibility under the waiver could allow a more holistic approach to helping people out ouf addiction. “When someone is provided all three of Central City's core services — employment, housing and health care — they are five times more likely to complete their outpatient substance use disorder treatment and be on a stable path to recovery compared to someone who's only receiving that SUD's treatment."

The renewal agreement made it official that the state will halt its decades-long, alone-in-the-nation practice of rationing health care for low-income children, which had led to denials of medically necessary care. The Lund Report's article describing mounting criticisms — including internal documents critical of the practice —caused state officials to schedule a meeting to discuss the article and the program's future. At the meeting, they decided to discontinue the practice, as described in interviews and emails released under the state's records law.

State officials also announced that by 2027 they will discontinue a related practice, the use of a “prioritized list” of approved services to ration care and limit spending, which has led to similar criticisms to those leveled at the program the state used for youths. The list had been credited with helping the Oregon Health Plan achieve financial sustainability.

Interestingly, federal officals have so far declined to approve four of the state's proposed changes to the Oregon Health Plan. Some elements are still in negotiation, state officials say.

Notably, federal officials have not yet approved a request to set up an alternate system to fund health equity initiatives that had sparked concerns among the health insurers and organizations contracted to serve Oregon Health Plan members, called coordinated care organizations. The proposal is to set up “Community Investment Collaboratives” that stand apart from the coordinated care organizations that oversee most of the care delivered under the Oregon Health Plan.

In addition, state officials say the federal government is still considering Oregon’s request for OHP coverage of youth in detention and adults who are in jail. Also described as “pending” is the state’s proposal for coverage that would start for adults in prison or in custody for psychiatric care for 90 days prior to release.

Another state request not approved today: State officials had requested a number of changes in tribal care under the Oregon Health Plan, including removing prior authorization requirements, expanding coverage of social need services, and converting a diabetes program into an OHP benefit. 

During the subsequent Oregon Health Authority press conference, when asked about which of the four not-yet-approved state requests he felt most optimistic about winning federal approval, Director Pat Allen said, “Boy, you're really asking me to tempt fate, aren't you? ...I think we're having productive conversations with CMS on all of those factors and I anticipate a positive outcome. I think it's hard to say exactly what the details will be on each of those four things.”

The federal government on Wednesday also approved renewal of the Medicaid program for Massachusetts.

You can reach Nick Budnick at [email protected] or at @NickBudnick on Twitter.