Field of Potential Medicaid Insurers Narrows

Health Share of Oregon is the only insurer that will apply to cover Portland’s Medicaid patients for the next iteration of Oregon’s Medicaid program after five potential applicants withdrew.

The coordinated care organization was among 18 entities to submit letters of intent to apply for a multi-million contract to cover Oregon’s Medicaid patients for the next five years. Three of Health Share’s subcontractors -- CareOregon, Providence Health Assurance, Kaiser Foundation Health Plan of the Northwest -- had also submitted letters of intent to cover Portland patients, raising the question of whether Health Share would remain the region’s only Medicaid payer.

CareOregon, Providence and Kaiser withdrew their intent to provide Medicaid coverage in Portland, according to updates released by the Oregon Health Authority on Tuesday. PacificSource and Moda also revoked their intent to coordinate care in Multnomah, Clackamas and Washington counties. Every county still has at least one applicant, a state press release said.

PacificSource said in a Feb.11 letter that it intends to support Legacy Health as part of Health Share’s application. Legacy owns half of PacificSource and is one of Health Share’s partners.

Moda spokesman Jonathan Nicholas declined to comment on Moda’s decision to withdraw applications from the three counties.

Moda also renamed two of its potential coordinated care organizations. If approved by the state, West Central Coordinated Care Organization, LLC would cover Lane County. Northwest Coordinated Care Organization, LLC would cover Clatsop, Columbia and Tillamook counties.

The revised letters of intent are the latest step toward Oregon’s largest procurement in history. The state’s existing Medicaid contracts expire at the end of 2019. It expected to pay upwards of $5 billion on the next five-year contracts.

Health Share intends to build on the successes and lessons learned from the first six years of coordinating Medicaid care, officials said in a press release Tuesday.

“Partnering around scarce Medicaid resources is the best way to serve (Oregon Health Plan) members in our community,” the release said.

The group had considered changing its structure to remove duplicate roles and extra administrative costs after critics questioned the need for a Health Share’s board to act as a middle layer between the Oregon Health Authority and its subcontractors. It remains unclear whether or not the Medicaid payer plans to restructure before applying for the next Medicaid contract or what a potential reorganization would look like.

“Reducing administrative costs and duplication is key to driving more resources to our community and supporting safety net services in the tri-county area,” Health Share’s press release said.

Oregon Health Authority spokesman Robb Cowie declined to comment on the change of potential applicants, citing the procurement process.

Coordinated care organizations’ applications are due April 22. Only entities that submitted a letter of intent are eligible to apply, but not all entities that submitted a letter are required to apply. The health authority plans to choose the state’s next round of Medicaid insurers in July.

Have a tip about health care? Contact Jessica Floum at [email protected].


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