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Oregon Bill Would Expand Medicaid Coverage To Undocumented Adults

Gov. Kate Brown supports a pilot project to spend $10 million on coverage to 2,000 adults, building on a program that now covers undocumented children in the state.
Oregon State Capitol in Salem. | RENAUDE HATSEDAKIS
March 16, 2021

Gov. Kate Brown wants to expand Oregon’s Medicaid system so undocumented low-income adult Oregonians can receive the taxpayer-funded health coverage. 

Brown testified Tuesday in support of House Bill 2164, which would would make adult undocumented residents eligible for Medicaid coverage if they meet income restrictions. 

The bill comes as Oregon and other states have focused on racial justice after a yearlong COVID-19 pandemic has highlighted inequities in the health care system. The pandemic has disproportionately hit communities of color hard, including Latinx people who work in frontline jobs in health care, agriculture and food processing. 

“Gaps in coverage persist, and these gaps  are disproportionately borne by communities of color,” Brown told the House Health Care Committee. “Everyone deserves access to health care. It’s the right thing to do, the just thing to do.”

If the legislation passes, it would start out as a pilot project with $10 million to cover up to 2,000 adults for one year. It costs the state about $5,000-$6,000 in combined federal and state dollars to provide Medicaid insurance to one person for one year. However, Brown said the $10 million is just a starting point.

As a first step, the state would focus on parents who have children or dependents in the Cover All Kids Medicaid program, which covers undocumented children under 19. The Cover All Kids expansion started in 2018 after lawmakers passed Senate Bill 557 in 2017. Since then, the program has enrolled nearly 6,000 children, according to a 2020 state report.

The program would have the same income limits that other Medicaid recipients face, which means they could not earn more than 138% percent of the federal poverty level. That means a single adult could earn up to nearly $1,400 a month and a family of four could have a monthly household income of $2,887. There would be higher income limits to cover pregnant women. 

The bill directs the Oregon Health Authority and Oregon Department of Consumer and Business Services to seek federal approval of the program. States are required to seek federal approvals -- technically known as waivers -- for changes they want to make to Medicaid. Oregon is currently working on its waiver renewal, which will be submitted in early 2022 before its current waiver expires on June 30, 2022. 

The proposed expansion represents just a sliver of the state’s Medicaid population. Medicaid covers about 28% of the state’s 4.3 million population. Medicaid enrollment has surged amid the COVID-19 pandemic as people lost jobs and commercial health insurance and signed up for the Oregon Health Plan, the state’s version of Medicaid.

Undocumented Population About 110,000

It’s uncertain how many unauthorized immigrants live in Oregon. A study by the Pew Research Center in 2016 put the figure at 110,000. It’s also unclear what portion of the unauthorized immigrant population lacks health insurance, but it is generally assumed that most do not have it, mainly because it is too expensive to buy commercial coverage.

Gov. Kate Brown’s budget proposal for 2021-2023 calls for $19.7 billion in OHP spending, with 73% of that, or about $14.3 billion, coming from the federal government. The rest comes from state sources, primarily $1.6 billion in general fund tax dollars as well as taxes on hospitals, tobacco products and insurers, among others. Medicaid provides free health coverage to residents who qualify based on their income. 

Overall, about 94% of Oregon adults are covered with either Medicaid, private insurance, Medicare or some other program. But disparities run throughout the system. Nearly 12% of the state’s population of Hispanics and Latinos is uninsured, the state estimates.

Oregon Health Authority Director Patrick Allen told lawmakers that figures about health insurance “can sound awfully dry and financial, but that’s not what this is about.”

It’s about providing people with care, Allen said. The Oregon Health Authority has a plan to eradicate health inequities by 2030.

Lawmakers Weigh In 

Lawmakers praised Brown’s bill as well as a similar bill on Tuesday, House Bill 3352. That bill would also make adults eligible for Medicaid regardless of their immigration status, but doesn’t designate a funding amount as Brown’s bill does. Brown’s bill doesn’t limit the number of undocumented people who could be covered, but starts out with a $10 million appropriation.

Bill sponsor Rep. Wlnsvey Campos, D-Aloha, said: “I know that the cost of this step forward may be higher than we think we can pay,” but urged lawmakers to consider the lives it would save.

Rep. Teresa Alonso Leon, D-Woodburn, another sponsor, said she supports both bills. She shared her experience as the daughter of migrant farmworkers growing up in Oregon. Her parents would often skip a doctor’s visit when sick to keep food on the table, she said. That continues today, she said, as immigrants delay doctor visits until they end up in the emergency room.

“Health care should be available and accessible to all communities in our state,” she said. “Health care should not be a luxury.” 

Rep. Maxine Dexter, D-Portland and a physician, and Rep. Lisa Reynolds, D-Portland and a pediatrician, both spoke in support of the expansion.

Everyone will benefit from the move, they said.

“In a global pandemic, we know our health is inextricably linked to the health of our neighbors,” Reynolds said.

Coordinated Care Organizations Back Bill 

The bill has widespread support in the health care industry. Coordinated care organizations,  physicians and advocates testified in support of the bill. No one spoke in opposition. 

Supporters include CareOregon, which serves about 450,000 people on Medicaid through its management of three coordinated care organizations: Jackson Care Connect, Health Share of Oregon and Columbia Pacific CCO. Those span Jackson County, the tri-county Portland metro area and Clatsop, Columbia and Tillamook counties. The state contracts with coordinated care organizations to provide Medicaid services in designated regions.

The expansion would help people get the care they need sooner, said Jeremiah Rigsby, chief of staff for CareOregon. Funding is key: Rigsby said the state needs a sustainable budget to be innovative. 

James Schroeder, chief executive officer of Health Share of Oregon, also spoke in support of the bill. The 380,000-member coordinated care organization serves people in the tri-county Portland area.

“Now’s the time for us to make that change and to start covering all people in Oregon,” Schroeder told lawmakers.

In submitted testimony, Schroeder said: “Supporting HB2164 is a moral issue for our CCO. We know those disproportionately impacted by an inability to obtain health coverage are largely from communities of color.”

All 15 coordinated care organizations signed a letter of support. 

Dr. Eva Galvez , a physician at Virginia Garcia Memorial Health Center in Hillsboro, spoke about her work with patients and the need for better coverage. Virginia Garcia is a federally qualified health center that works with immigrants and other under-served and low-income patient groups. 

In one instance, Galvez said, a patient came in with diabetes who had lost 20 pounds after rationing insulin and delaying care to save money.

“It’s about removing barriers so families can lead productive lives,” Galvez said.

Dr. Anna Pierzchala, a family doctor at Kaiser Permanente, echoed that sentiment, saying that when parents are insured, children are more likely to come in for care and stay healthy.

You can reach Ben Botkin at [email protected] or via Twitter @BenBotkin1.