Oregon’s Medicaid system hasn’t yet been strained by the coronavirus-induced economic freefall -- but mainly because many of the newly unemployed aren’t immediately applying for the subsidized health insurance, the head of Oregon’s Medicaid program said.
“People only sign up for health insurance when they really need health care,” Lori Coyner, director of Medicaid at the Oregon Health Authority, told The Lund Report. Social distancing, postponement of non-essential medical procedures and other steps have sharply reduced the number of Oregonians seeking health care in the short term, she said.
Until the pandemic begins to subside, “I don’t think we’ll see a big increase in (Medicaid) membership,” Coyner said.
The Oregon Health Authority may need to ask the state Legislature for more money to cover a rise in Medicaid membership, Coyner said. But she said the agency has not yet developed estimates of how much extra money might be needed or how many new members might sign up. The program already covers about 1 million Oregonians.
State officials expect the Legislature to meet in coming weeks to try to address a raft of problems created by the virus. The health agency will need to have estimates ready by then, Coyner said.
The ranks of the unemployed are swelling fast. The state on Thursday announced 107,000 Oregonians filed initial unemployment claims last week, taking the state total for the past three weeks to 269,900. If all those claims are accepted, they would push the state’s jobless rate to about 17 percent, far outstripping the 11.9 percent set at the depths of the Great Recession in May 2009.
Oregon’s Medicaid system, the Oregon Health Plan, pays regional insurers about $6 billion a year to cover the health care needs of one in four Oregonians. The health agency has said it doesn’t have substantial reserves to cover a sharp rise in members on the plan. On average, the state pays about 25 percent of the cost of each member’s care, and the federal government pays the balance.
For now, the newly jobless appear to be focused on getting their unemployment money flowing.
“We haven’t seen a big increase (of Medicaid applicants) in the last three weeks, and I don’t expect we’ll see one in the next few weeks either,” Coyner said.
One reason is that at least some employers are furloughing workers – rather than laying them off outright – eliminating their pay but continuing to provide them with company health care insurance for the time being, Coyner said.
Even without many new enrollees, Oregon’s Medicaid ranks are steadily growing. That’s because a new federal law, the Families First Coronavirus Response Act, bars states from dropping Medicaid members unless they move out of state. In Oregon, that means about 20,000 people a month who typically would be purged from the Medicaid ranks for various reasons are being kept on, Coyner said.
On the plus side, that same federal law provides a temporary boost of 6.2% in Medicaid payments to states. Coyner said the state is calculating how far that extra money will stretch in covering additional Medicaid members. The money could come out to about $20 million a month for the duration of the crisis.
Coyner said she expects the federal government will continue to honor its legal obligation to cover its share of any increase in Medicaid costs in Oregon triggered by virus-caused unemployment. Oregon’s agreement with the federal government doesn’t limit on how many new members the state signs up, she said.
The “pain point” will be with the state coming up with its matching funding, she said. Using a mix of federal and state money, the state health agency pays insurers an average of about $6,000 per year per Medicaid member for health coverage. Depending on a member’s Medicaid status, the state is responsible for between 10% and 38% of that sum, Coyner said.
Coyner said her agency is working with the state’s coordinated care organizations, the insurance companies that are paid by the state to cover Medicaid members, to make sure they are ready to enroll an anticipated surge in members. Plus, the insurers must make sure the health care providers they contract with – hospitals and medical and mental health providers – are willing to handle the increased Medicaid membership, she said.
While the state is working on estimates of how the COVID-19 crisis will affect its Medicaid program, some others are not being reticent.
In a report last week, the consulting firm Health Management Associates projected that if Oregon’s unemployment rate rose to 17.5%, some 286,000 people would lose their employer-sponsored health coverage, and 232,000 people would join Medicaid.
If the jobless rate rose to 25%, some 320,000 people would join Medicaid after losing their company health insurance, the study projected. An extra 320,000 members could cost the state $1.9 billion a year in combined state and federal money.
You can reach Christian Wihtol at [email protected].
