State May Seek More Straight-Forward Medicaid Waiver to Bolster CCOs

By pulling back on the Medicaid waiver, Oregon may be able to be assured that the reforms launched in 2012 can get approved before President Obama leaves office.

The governor’s top healthcare policy advisor told a state panel Wednesday morning that the state may seek a straightforward renewal of its Medicaid waiver while President Obama was still in office, and pull back on more aggressive innovations to use medical dollars for social determinants of health.

“With a straightforward extension, the governor hopes we continue the momentum to go further upstream,” Jeremy Vandehey, Gov. Kate Brown’s healthcare advisor, told the Medicaid Advisory Committee. “We’re trying to find a path forward before the end of this administration.”

Vandehey said that Oregon had hoped to push the federal government further than it has gone before to use Medicaid dollars to assist recipients with things like housing that are critical to a person’s health, and an acute problem to their well-being, given the West Coast housing shortage.

But those conversations with the Centers for Medicare and Medicaid Services would have been a heavier lift -- by pulling back, the state stands a better chance of getting a waiver approved without risking the progress the state has already made to rein in healthcare costs and improve the health of its neediest residents through locally driven coordinated care organizations.

“It’s been very clear that CMS is very much excited about the work that Oregon has done,” Vandehey said.

Last week, an Oregon Health Authority official noted that Arizona won a huge Medicaid waiver in the lame-duck session of President Clinton, without needing to wait for President George W. Bush’s administration to get off the ground.

The remarks reflect the new realities brought by the shocking election of Republican Donald J. Trump to the presidency and the murky future for America and its healthcare system.

If Democrat Hillary Clinton had won as anticipated, the state could allow the Medicaid approval to carry over into her term with an expectation that the federal attitude to Oregon’s Medicaid reforms would be similar, but now Oregon policymakers don’t know what to expect.

Vandehey said if Oregon gets its current regimen approved, it could then follow-up after it gets a sense of how the federal health agencies operate under Trump.

Trump campaigned on scrapping Obamacare, and although he has since backpedaled on how much he’ll rescind the popular parts of the Affordable Care Act, he has announced a far-right pick for Secretary of Health & Human Services, Rep. Tom Price, R-Ga., who has not only led the charge to end the ACA, he opposes Medicare and wants to convert it into a voucher program for seniors.

Price and House Speaker Paul Ryan, R-Wis., have also mused about turning Medicaid into a block grant.

In a progressive state like Oregon, a block grant might actually allow the state to invest more freely in non-clinical healthcare needs, such as social determinants of health, which regulators in Washington, D.C., would otherwise be more reluctant to accept.

Vandehey noted that the CCOs have already made investments in social determinants of health, and they could continue to do so.

But those investments may become more difficult in the next budget cycle, as Brown has recommended trimming the administrative payments given to CCOs, as well as not increasing some payments to adjust for inflation.

Brown’s budget proposal argues the CCOs could sustain these cuts because of the large payments the CCOs were given in the first years of the Medicaid expansion. Her budget also defunds the General Assistance program, which provides a route for homeless people -- who receive Medicaid benefits -- to get into housing, primarily by pulling in federal money.

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