State lawmakers and other officials on the front lines of health care policy shared their views at CCO Oregon’s annual conference Thursday, urging the system leaders – and the state’s next governor – to keep a steady hand at addressing a set of complex needs.
The need for improved programs and funding was a major focus as the Legislature prepares to meet for its long session in 2023.
Almost 300 people gathered for the conference in person for the first time since 2019. CCO Oregon’s membership includes health care providers and coordinated care organizations, which contract with the state to provide coverage to members of the Oregon Health Plan.
The meetings occurred at a time of turmoil and change.
The state is preparing to resume federally mandated eligibility checks that will discharge an estimated 300,000 people from the Oregon Health Plan rolls. Staffing shortages are fueling a hospital capacity crisis.
Meanwhile, the federal government recently approved changes to the program including extended coverage for children under 6 and new spending for health-related needs like housing and food.
The state’s behavioral health system, meanwhile, has seen its share of problems, from a sluggish rollout of $1 billion of new money to admissions problems at Oregon State Hospital, the state-run psychiatric residential facility.
Two panels featured lawmakers who spoke about health care and behavioral health. In the panel behavioral health panel, when asked about the next legislative session, Tawna Sanchez, D-North and Northeast Portland said the state needs to look for ways to continue the focus of the 2021 session, which put more than $1 billion into the workforce and new programs and facilities to grow the system. Another priority: the state needs to increase reimbursement rates for behavioral health providers to support better pay, Sanchez said.
Rep. Raquel Moore-Green, R-Salem agreed, saying it’s crucial for behavioral health providers to have pay parity with other providers.
The state’s strained workforce also needs attention, Sen. Kate Lieber, D-Beaverton, said.
‘We’ve got to reduce the caseloads for people,” Lieber said. “We’ve got to figure this out.”
Lieber said the state needs to reduce the administrative burden for behavioral health providers so they can spend more time with patients.
Dana Hittle, interim Medicaid director at the Oregon Health Authority, agreed. “I do not want behavioral health clinicians to be spending 90% of the day” on paperwork, Hittle said.
Multnomah County Circuit Judge Nan Waller said people need more places to go during times of crisis besides jail. It’s important that people aren’t simply stabilized and then released back onto the streets without follow-up support and care, Waller said.
Waller said the complex issue doesn’t offer a single solution.
“I’m not the wizard about how you do it,” she said.
Panelists also discussed the state’s Oregon Health Plan waiver approval, announced on Wednesday. The plan includes $2 billion in new federal funding while ensuring continuous enrollment for children under 6, a two-year enrollment period for people above 6 and flexibility to spend $1.1 billion of that money on services related to housing, food and climate-related programs.
“Moving forward in the next iteration of CCOs, our focus is really going to be on implementing those flexibilities we achieved through this waiver application,” Hittle said.
The Post-Pandemic Outlook
Another panel of lawmakers looked to the future of health care in Oregon.
Rep. Rob Nosse, D-Portland and chair of the House Interim Health Care Committee, said the state will face challenges as it works through the soon-to-be resumed eligibility checks that guide who qualifies for the Oregon Health Plan. During the COVID-19 pandemic, a federal rule blocked states from conducting the checks, leading the plan’s rolls to swell to 1.4 million people.
Nosse praised the work done through House Bill 4035, which set guidelines for the eligibility checks designed to protect the most vulnerable, and also laid groundwork for a ‘bridge plan’ to cover Oregonians who make too much to qualify for the Medicaid-funded OHP but still struggle to afford care.
“Our state to its credit is trying to figure out how to keep people insured,” Noose said, adding that it will be a “messy and difficult” process.
“That’s just going to be a challenge that we’re going to have.”
Other advice Nosse offered: Don’t be afraid to try complex information technology rollouts, despite the state’s lackluster record on that front.
Nosse said the state should “wait a little bit” to launch significant reforms of the CCO model given the many challenges the state is facing right now. “I would say let’s not be in a rush to do that,” Nosse said.
Members of the panel agreed that the workforce challenges in health care have many dimensions. For example, even students who get full scholarships often cannot attend college because housing is expensive, said Rep. Teresa Alonso Leon, D-Woodburn.
Sen. Dick Anderson, R-Lincoln City, agreed, saying limited housing deters people from accepting jobs in his coastal district.
The other side of that is recruiting teachers. Sen. Elizabeth Steiner Hayward, D-NW Portland/Beaverton, a primary care physician who teaches at Oregon Health & Science University, said pay for faculty needs to be competitive.
“If we do not pay our faculty at every level well, how do we expect to get the best and the brightest into teaching?” Steiner Hayward said.
She said whoever takes over as Oregon’s governor in January should try “not to make changes quickly” in the Oregon Health Authority’s leadership.
“Are they perfect? No,” Steiner Hayward said. “Are they damn good? Yes.”
There’s no need to move quickly, she said: “Don’t fire people right away.”
Rep. Wlnsvey Campos, D-Aloha said affordability should remain a focus.
“We have to keep having these conversations about how health care is affordable and accessible,” Campos said.