Health officials are preparing to reach out to the estimated 300,000 Oregonians expected to lose their health coverage as the federal government begins unwinding pandemic provisions.
For nearly three years, to preserve coverage, the federal government suspended the requirement that states verify that Medicaid recipients qualify for the low-income health insurance program.
As a result, the number of people enrolled in the Medicaid-funded Oregon Health Plan soared to nearly 1.5 million between March 2020 and January 2023, according to state numbers.
Beginning April 1, those people will be asked to prove they still qualify for the program as state officials comb through Medicaid rolls to see who is still eligible. Oregon residents who earn up to 133% of the federal poverty level — roughly $37,000 a year for a family of four — are eligible for the Oregon Health Plan.
The process won’t happen all at once. Rather, it will be spread out over a 14-month period in stages intended to minimize disruptions for the people affected.
State Sen. Deb Patterson, a Salem Democrat who chairs the Senate Health Care Committee, told The Lund Report that tracking down people to determine their eligibility after the three-year reprieve might be difficult.
“It will be a surprise for some people,” she said.
Oregon Health Authority Director James Schroeder told a legislative panel last month that reaching all Oregonians affected by redetermination is an “all hands on deck” situation.
“Historically, the main reason that people do not complete redetermination and stay on Medicaid is because they don’t respond,” he said.
Schroeder told lawmakers that the health authority has sent out requests for information to Oregon Health Plan recipients over the last three years and nothing has happened if they didn’t respond.
“That has changed,” he said.
Dana Hittle, state interim Medicaid director, told The Lund Report the Medicaid redetermination process will be successful if as many eligible Oregon Health Plan recipients as possible keep their coverage and others are steered toward other insurance options.
The timeline for when Oregon Health Plan recipients are contacted to see if they remain eligible will vary depending on each individual’s circumstances, she said. More vulnerable members or with complicated circumstances will be given more time.
“There is no way that this is going to be a perfect or easy process for our (Oregon Health Plan) members or for the state or any state for that matter,” said Hittle.
Oregon Health Plan recipients will have 90 days to respond after receiving a request for information that’ll be used to determine their eligibility, she said. If they don’t respond or provide incomplete information, they’ll get a notice that they’re losing their eligibility and will have another 60 days to respond, she said.
Some recipients might respond to the health authority’s requests for information right away and will be found to be ineligible because their income changed, she said. The first wave of ineligibility notifications could arrive in mid-May, she added.
The health authority’s eligibility review of the Oregon Health Plan rolls will begin with recipients expected to meet eligibility requirements, she said. That group will include people who have already cleared requirements to receive Social Security Income for disabled adults.
“We’re front-loading those individuals that we think can be basically auto-renewed,” she said. “So those are people in certain eligibility categories whose incomes and circumstances don’t generally change.”
The health authority will later take a look at the eligibility of Oregon Health Plan recipients who might be harder to reach or need more support to determine if they qualify, she said. Those will include pregnant women and newborns covered by the Oregon Health Plan or minors who turn 19 and are no longer eligible.
Other recipients who are receiving services through the Oregon Department of Human Services will have their eligibility reviewed throughout the redetermination process, she said.
State health officials are hoping that Oregonians who found to longer be eligible for the Oregon Health Plan will enroll in employer-sponsored coverage or a plan sold on the health insurance marketplace that offers subsidized premiums to people earning up to 400% of the federal poverty line.
Another landing spot envisioned for people booted from the Oregon Health Plan is a proposal called a Bridge Health Program. If approved as expected, the new program will be open to households who make between 138% and 200% of the federal poverty level, and is designed to keep a portion of disenrolled Oregon Health Plan recipients insured.
A task force created by the Legislature to work out details on how the new program would operate finished its work in December. The Oregon Health Authority is planning to submit a waiver in July to the federal government seeking approval for the new bridge program, health authority spokesperson Amy Bacher told The Lund Report in an email.
While waiting for approval of the new program, the health authority is also asking the federal government to temporarily allow people with incomes of up to 200% of the federal poverty level to stay on the Oregon Health Plan while eligibility redeterminations are completed, Hittle said.
Hittle expects the waiver will be approved this spring and will affect an estimated 45,000 to 55,000 people currently on the Oregon Health Plan recipients. Those approved for the new bridge program will remain covered by their current coordinated care organization — the term for regional insurers contracted by the state to oversee the care of Oregon Health Plan members.
The federal government is requiring states to finish determining who’s eligible for Medicaid in 14 months, Hittle said.
“I would love to be able to say that it’s going to be all done and everything is gonna be great by the end of those 14 months,” she Hittle. But she added, “We don't know.”