Rep. Cedric Hayden, R-Cottage Grove, said the Oregon Health Authority has a financial incentive to delay moving pregnant women into coordinated care organizations, which may have prevented these women from getting access to the full array of health benefits available to them, particularly dental care.
Most low-income women gained access to the Oregon Health Plan when the state expanded Medicaid in 2014, but a narrow band of women -- in households with income levels between 139 and 185 percent of poverty -- receive Medicaid only during their pregnancy and for three months of post-partum care.
The state receives federal funding for these women on a capitated, per person, basis, but Hayden believes the Health Authority has been keeping this money for itself rather than using it to pay dentists and other health providers.
As a dentist, Hayden said he occasionally gets women who have are on the Oregon Health Plan solely because of their pregnancy, and he will typically offer them charity care rather than hassle with the state. The paperwork involved is laborious, the payment rate is low, and once the state sees a patient is actually accessing care -- and costing them money -- they usually get moved into a CCO.
But until then, they are in limbo, not using care, even as payments come into the state. These women are often uninsured outside of their pregnancy, and subsidized exchange medical plans do not include dental care, unlike the Oregon Health Plan. The nine months to a year that they receive state assistance may be the only time these women can afford to see a dentist and take care of tooth problems that may be critical for the nutrition of their babies.
Oregon Health Authority spokeswoman Courtney Crowell did not respond to Hayden’s comments. Hayden said the Health Authority has stonewalled him for months when asked to provide data or come up with a plan for getting the women into a CCO system. There are about 6,600 women in this group at any given time.
There’s a separate group of pregnant women separated from the CCOs because of their immigration status -- but Hayden said they ironically receive better care than the women who are citizens because they’ve been referred to safety-net clinics such as Virginia Garcia in Yamhill County.
Mothers of babies born in Oregon are eligible for Medicaid, but both legal and unauthorized immigrants are otherwise barred from receiving the Oregon Health Plan for five years after establishing residency. The program for these mothers is called the Citizen Alien Waived Emergency Medical benefit, or CAWEM, for short.
“[CAWEM] gets pretty good access through federally qualified health centers for primary care,” Hayden said.
The two groups of pregnant women have roughly the same number of people. But while the state spent $1 million for dental care on the immigrant group in 2013 and $1.6 million in 2014, it spent just $23,000 on dental care for the poor citizen women in 2013, rising only to $37,000 in 2014.
“Pregnant woman on Medicaid who are not CAWEM and not enrolled in a CCO, may experience barriers to dental care for a variety of reasons,” Crowell said in December. “OHA is currently working to better understand how often they utilize dental services, as well as other prenatal care, and will report on that in the near future.”
Some of the women may choose to be outside the CCO system because they wish to use a direct-entry midwife, which CCOs generally have been unwilling to employ.
But so long as they receive care outside the CCO system, these women have minimal access to certain care because of the very low rates paid to providers on a fee-for-service basis, and they have almost no access to a dentist.
Hayden has tried to improve dental access to these women for nearly two years. He introduced legislation in 2015 but the Health Authority helped scuttle that legislation, offering instead to study a way to get these women more quickly enrolled in CCOs. An OHA report has still not surfaced, and Hayden said this week that he will likely move forward with legislation to force a fix to the problem that the Oregon Health Authority has been slow to solve.
“OHA does not have a pool of providers for these patients,” he said. “They’re leaving it up to the patient to find access.”
The Health Authority could direct citizen women in the pregnancy program to these centers, but for some reason it does not. Hayden said his bill could either require these women to come into CCOs to begin with, or, at minimum, direct the OHA to assist them with information about accessing the safety-net clinics -- which it’s doing for immigrant women.
Chris can be reached at [email protected].
Advantage Dental offered last session to take all of the women on this program on a capitated basis and work towards getting them all appointments during their pregnancy. But for some reason this did not go anywhere. It is well known that women whose children are at risk for tooth decay should be seen while they are pregnant to do interventions on those deemed at risk. It has been shown that appropriate interventions on at risk pregnant women lower the amount of tooth decay in their subsequent child. I commend Dr. Hayden for his concern about a population at risk for oral disease which results in potential misery for the pregnant women and tooth decay and potential suffering in their newborn. I know OHA wants to work out a solution for this population and it is too bad it has had to reach the frustration level.
Mike Shirtcliff