State lawmakers have taken up a plan to maintain coverage for an estimated 300,000 Oregonians who face removal from the state’s health insurance plan for low-income residents when the federal COVID-19 public health emergency ends.
Spearheaded by Rep. Rachel Prusak, D-Tualatin/West Linn and chair of the House Health Care Committee, the effort aims to provide Oregonians with seamless health coverage when their income rises above the federal threshold that determines their eligibility for the Medicaid-funded Oregon Health Plan.
With a likely deadline looming, supporters say the work must unfold quickly, and they intend for House Bill 4035 to be the vehicle.
The bill received its first hearing Wednesday in the House Health Care Committee, as lawmakers continue to work on an amendment that would contain the details.
It’s unusual for major public health policy changes to come forward in a short, 35-day legislation session. But time is of the essence. Here’s why: When the COVID-19 pandemic started, federal officials made a change to keep everyone enrolled in Medicaid, including Oregonians on the Oregon Health Plan. This meant that changes like an increase in income that normally would disqualify them didn’t.
But when the federal public health emergency declaration ends — currently slated for April 15 — officials will have to verify who among the 1.4 million Oregonians enrolled in the Oregon Health Plan is still eligible, a process called redetermination.
Officials estimate that about 300,000 of those currently on the Oregon Health Plan could be found ineligible — the same number that enrollment grew during the pandemic.
“This is going to be a very important issue that we address in this committee,” Prusak said at the hearing.
Impact could be large
State officials say that with fewer people bouncing off the Oregon Health Plan under the temporary federal rule, the state’s uninsured rate went from 6% in 2019 to 4.6% in 2021, a record low.
That trend also translated into gains for historically underserved groups. Black Oregonians had an uninsured rate that dropped from 8% to 5%.
For the Oregon Health Authority, it presents a challenge: making redeterminations in a way that keeps those gains intact and, ultimately, keeps as many people as possible covered.
The bill will require that the state complete the redetermination process in a way that “really ensures we lose as few people as possible,” Jeremy Vandehey, the authority’s director of health policy and analytics, told The Lund Report.
Rather than do the redeterminations immediately, as some states are planning, state officials are considering a phased-in approach that would complete the redeterminations across a 12-month period with the population divided into groups. At that clip, as many of 25,000 Oregonians could lose coverage each month.
During that time, however, the authority could take steps like temporarily extending eligibility for easier transitions. Easy cases would get a determination first.
State officials said Wednesday that people in high-risk groups would get reviewed later in the year, as defined by factors such as income levels or if a person has a disability, chronic health conditions or is close to aging out of the Medicaid system.
The bill would set up a task force to deal with a problem that went away while Medicaid disenrollment was halted: the so-called “churn” in the Oregon Health Plan — the constant flow of people who enroll and then become disqualified after changes to their income, many of whom later become qualified again. Generally, to qualify for the Oregon Health Plan, a person’s income needs to be at 138% of the federal poverty level or lower. People also leave the system and reenter for other reasons, such as a loss of employment.
To keep people enrolled, the task force in that bill would consider a so-called “bridge plan” that allows enrollment on the health insurance marketplace — essentially a basic health program similar to those already set up in New York and Minnesota. Under such plans, states take federal tax credit discounts that income-qualified individuals receive on the marketplace and divert them to instead enroll people in a state program. In Oregon, it would be the coordinated care organizations, the insurers that the state contracts with to provide care under the Oregon Health Plan.
The program would be available to people with an income level of 138% to 200% of the federal poverty level. For a family of two, that would represent an income ranging from about $24,040 to nearly $35,000, according to federal poverty guidelines.
Officials aren’t sure yet how much the cost in state dollars would be and are still working on estimates for upfront costs. But the goal is to build a program that operates on federal dollars only, officials say.
The legislature’s Emergency Board, which meets when lawmakers aren’t in session, would need to sign off on the plan, possibly as soon as May.
From there, it would go to the federal Centers for Medicare & Medicaid Services for approval.
At the forefront the goal is to keep people enrolled in seamless coverage so they continue to receive primary care and treatment before they need a trip to the emergency room.
“Not going backwards is really important,” Vandehey said, adding that the pandemic has demonstrated the benefits of continuous coverage.
“Preserving these gains of people being insured is really important.”
He said community engagement and outreach would be a key part of the work and that planning cannot wait until the longer legislative session next year.
“By the time we get to the 2023 session, we will most likely be well into the redetermination process,” Vandehey said.
The issue weighs heavily on working class families, including essential workers who have worked in home-care and long-term care facilities during the pandemic, said Felisa Hagins, political director for Service Employees Local 49, at the Wednesday hearing. The local represents more than 85,000 workers in Oregon, mostly in health care. She said many of the local’s members became eligible for Medicaid and stayed enrolled during the pandemic. But now they have returned to work and are unlikely to qualify Medicaid after a redetermination, Hagins said.
“To avoid going backwards, we call on you to adopt a robust plan and give OHA the tools they need to work with the federal government to keep Oregonians covered, especially people who fall into the 138% to 200% of poverty and earn too much to enroll in Medicaid but not enough to afford a Marketplace plan even with a federal tax credit,” Hagins said in submitted testimony.
Testimony will continue Friday on the bill.