Quick Look: Oregon Health Authority Policy Keeps Medicaid Members from CCOs

Only 15 percent of Oregon Health Plan income-based members have seamless coverage at renewal time. Rep. Cedric Hayden wants to pull enrollment from OHA and give it to DHS, and require that lapsed members be put immediately back into the CCO that was serving them.

Medicaid members must renew each year. At enrollment time, the Oregon Health Authority mails them a bewildering 30-page application booklet and waits for them to respond; Medicaid, also known as the Oregon Health Plan, is the healthcare program set up to serve the poor and disabled and includes a high number of homeless people and people with difficulty reading English.

Unsurprisingly, a majority of members are lapsing in coverage; when they renew late, the Oregon Health Authority is detouring them from the local CCO that had been managing their care, and instead placing them in its so-called “open-card” system, where their medical needs are provided through a limited network and paid out a claim at a time through a third-party administrator, Kepro.

Last week, Republican Secretary of State Dennis Richardson released an audit showing that 71,000 people were hanging on to Medicaid benefits without proof they are still eligible for those benefits. His release followed a story in the Oregonian that showed 14,000 people were having care terminated for ineligibility.

But a far greater number of people are likely being kept from their eligible medical benefits because of the tortuous re-application process, and roughly 30,000 people at any given time are marooned in the open-card system. In addition to poor access compared to the CCOs, this alternative system lacks the coordination reforms of the CCOs, which have lowered costs for the state while improving care for these vulnerable citizens, which Oregon officials regularly note is a model for the nation.

“That’s where your audit ought to be,” said Rep. Cedric Hayden, R-Cottage Grove. “The CCOs miss out on the money … by the delay in getting eligibility processed,” Hayden said. “It is lost money to the system of hundreds of millions each biennium due to slow processing.”

Click here to read the full premium version of this story, which looks at the drop in Medicaid enrollment in Oregon since stricter CCO re-enrollment rules were enacted, and also examines a proposed $575 million hospital tax increase.

Reach Chris Gray at [email protected].

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