Skip to main content

With glitches fixed, Oregon Health Plan eligibility checks to resume

After problems led to thousands of Oregonians incorrectly disenrolled, the state has made fixes, restored coverage and will soon resume eligibility checks that were on hold during the pandemic
February 22, 2024

Oregon health officials are gearing up to resume long-delayed eligibility checks for the state's health plan for  low-income people after pausing to address glitches that prompted federal concerns and a six-month delay.

As a result, some Oregon Health Plan members will stay in the program a little longer before having to submit renewal applications for approval. The delay means it’s a good time to verify that your address and contact information with the program are up to date, officials say. And if you have an online state benefits account, make sure you know how to check it for renewal letters.

Last April, the state joined others in launching the resumption of eligibility checks for the program that offers free health care to low-income people, the state’s version of Medicaid. 

Renewals had been paused during the pandemic, during which Oregon Health Plan enrollment jumped from 1.2 million people to 1.5 million, or more than one in three Oregonians. 

Ten months after starting the checks, Oregon continues to rank among the states that have kept the largest proportion of enrollees retained in the low-income program after undergoing income verification — thanks in part to Oregon's move to increase the upper income limit allowing people to remain in the program.

But starting last fall, the state had to push back its schedule to complete the federally required renewals. Officials needed to make fixes and secure federal approval for a six-month extension to complete the process. Part of the issue was problems with renewal notices, and errors that led to approving ineligible people and denying coverage to people who should have received it — issues connected to the long-troubled state eligibility system called ONE.

“It made this extension necessary so that we could fix the things that we needed to fix,” said Vivian Levy, Oregon's interim Medicaid director, of the problems that prompted federal concerns. She added that the state alerted federal officials to the need for delay last fall. 

“We told them that we were going to need an extension. But we needed to work through how long it would take to change the things we needed to change and restart those renewals," she said. “We had to go back to (the federal government) and say, ‘We've made these changes. We have a schedule now and here's our plan.’”

On the plus side, Levy said, the pause allowed Oregon to make changes to accommodate enrollment of people regardless of immigration status to implement the Healthier Oregon program, as well as people with higher income levels thanks to plans to institute expanded health coverage for the working poor.

“There were a number of things that were done to improve the system,” Levy said. “And also, we are engaging in outreach in a way that we in a way that is unprecedented.”

Federal approval of Oregon’s requested extension to complete the renewal process came Feb. 13. In all, the process is expected to take 20 months, not the 14 initially planned. And starting in June, people enrolled in the Oregon Health Plan who’ve not yet been renewed should keep a close eye on their mailboxes, officials say.

“For folks who have not already gone through a renewal since last April, we will start sending out renewal packets again in June,” Levy said. “And those will be going out between June and September of this year. That's when folks should be on the lookout.”

Among the issues disclosed last fall:

  • Around 11,700 members who did not respond to renewal requests received incorrect approval notices instead of closure notices. The state gave them through the end of 2023 to respond or be disenrolled.

  • At the end of September the state ended benefits for 2,268 people incorrectly, only to restore them. Also, 1,226 received notices incorrectly informing them that their benefits were ending at the end of October.

  • The state had to restore coverage to 20,00 people who were legally blind, were seniors or had a disability who'd been disenrolled due to problems in the notices the state informing them that they were too wealthy to keep their benefits. The state has since reworked the notices to include options such as spending down financial resources to remain eligible.

Oregon was not the only state that sparked federal concerns last fall. More than 30 did in all and many had to make changes to address problems.

Changes fueled steady enrollment, not the drop expected

About 27,000 people who would have lost coverage because they made too much money for Medicaid will keep it during the ramp-up of a new program called the Oregon Bridge Plan. The new program will cover people who make as much as 200% of the federal poverty level — a roughly 50% increase over the federal Medicaid limits, expanding care to a larger proportion of people who are working but still are poor.

Meanwhile, Healthier Oregon has enrolled 75,000 people into the Oregon Health Plan, including adults who gained eligiblity on July 1, 2023. 

As a result of these changes as well as new enrollees coming into the program, state Medicaid enrollment that had been expected to drop to 1.2 million at the end  of the eligibility checks is instead holding steady, close to 1.5 million Oregonians.

In all, 107,000 cases are yet to go through the renewal process, according to the state. Those cases may include families and households.

According to figures released by the state in a Feb. 21 press release, the state has completed more than 85% of the 1.5 million eligibility checks it needed to conduct. As of Feb. 17 at least 1,241,196 people have completed the renewal process.

Of those, 187,789 people (15.1 percent) were found ineligible, according to the state.

That tally does not include another 15,076 people who lost Oregon Health Plan coverage but were able to continue Medicare Savings Programs that help pay their Medicare costs.