This story has been updated with additional reporting.
As soon as next year, state health officials could use dollars from the Medicaid-funded Oregon Health Plan to temporarily cover some low-income Oregonians’ rent or buy them air filters to protect against wildfire smoke.
The Oregon Health Authority on Wednesday announced the proposed timeline for rolling out its five-year Medicaid renewal, which the federal government approved a year ago. Often referred to as a federal waiver, the plan means Oregon will join a handful of other states that spend Medicaid funds on housing or food to improve the health of people on the low-income insurance program.
The $1 billion plan also makes Oregon the first state to use Medicaid funding to ease the effects of climate change on low-income Oregonians.
If federal authorities sign off on the hoped-for schedule, eligible members of the Medicaid-funded Oregon Health Plan will see the program pay for “climate-related supports” by January 2024. Among other benefits, those supports are intended to make it easier to use Medicaid money to buy air conditioners to prevent medically vulnerable Oregon Health Plan members from seeing their health worsen during heat waves.
Oregon’s unique Medicaid system is designed to give coordinated care organizations, regional insurers that oversee services, flexible spending to address members medical needs. That flexibility means coordinated care organizations could use Medicaid money to purchase an air conditioner to help manage a member’s health condition.
Health authority interim director Dave Baden told The Lund Report that the new Medicaid plan will mean funding to pay for home modifications, air conditioners or other items that will help Oregon Health Plan members manage health conditions that are affected by more extreme weather.
“Instead of a CCO having to look at what they have available in their flexible spending after medical and administrative costs, this is a more dedicated funding pot that can be used for that,” he said.
Up next under the proposed timeline are housing benefits. By November 2024, the health authority could spend Medicaid funds on up to six months of temporary rent assistance for Oregon Health Plan recipients, starting with those at risk of losing their current housing.
“The new Medicaid waiver is bringing a unique opportunity to Oregon that can help bridge the gaps between our state’s healthcare and housing systems offering care and stability for our most vulnerable neighbors.”
“We’ve always known stable housing is healthcare,” Cole Merkel, co-director of HereTogether Oregon, a coalition formed to address homelessness in the Portland area, told The Lund Report in an email. “The new Medicaid waiver is bringing a unique opportunity to Oregon that can help bridge the gaps between our state’s healthcare and housing systems offering care and stability for our most vulnerable neighbors.”
The benefit is intended to prevent Oregon’s homeless population from growing and protect people from losing their housing because of a health issue.
An estimated 125,000 Oregon Health Plan members meet the federal definition of being “at risk for homelessness” and would potentially be first in line for the new benefit, according to a statement from the health authority.
Health authority officials also intend to use Medicaid funding to keep Oregon Health Plan members housed while undergoing treatment for a mental health or substance use disorder, preventing their condition from worsening after ending up on the streets.
Under the state’s five-year Medicaid plan, housing benefits would be extended to other Oregon Health Plan members, such as those already experiencing homelessness, at a later unspecified date, according to the statement.
Oregon’s 16 coordinated care organizations, regional insurers that oversee Medicaid services, will play a central role in administering the new benefits. The funds will flow through the coordinated care organizations, which will work with other groups or businesses.
Lee Dawson, spokesman PacificSource Community Solutions, told The Lund Report in an email that the coordinated care organization is hiring a new vice president of community health to lead the administration of the new benefits. He said while the health authority is still working out criteria for the benefits, coordinated care organizations already help connect members to climate, food and housing services.
"However, meeting the full vision of the (new Medicaid plan) will require new skills, systems and partnerships – especially with food and housing providers – and any time there is new work or new requirements, there is a lot of learning, sharing information and relationship building," he said.
Tracy Forsyth, spokesperson for coordinated care organization Health Share of Oregon, told The Lund Report in an email, “There is still a lot to work out about how this will be implemented.” She said that coordinated care organizations will determine which of their members meet the criteria for the new benefits.
“CCOs will have the ability to work with their communities to identify interested providers and community partners,” she said. “Payment methods might also vary depending on the types of services provided – for example, CCOs might make direct payments for air conditioners, but might work through community partners to facilitate access to housing supports.”
Baden said a caseworker at a nonprofit could check to see if an Oregon Health Plan member is eligible to have Medicaid pay for their housing along with other benefits, such as Section 8 or Housing Choice Vouchers. The nonprofit could then bill the coordinated care organization for the housing benefit, he said.
“What we really want to do through the money that's flowing down through CCOs is have Medicaid and this new benefit sort of interwoven into a broader set of other housing benefits,” said Baden.
Under the proposed timeline, the health authority will begin using Medicaid money by January 2025 to also buy food for Oregon Health Plan members to improve their health.
Baden said that a big challenge will be connecting members to the new benefits. He said that might be easier in smaller communities where a coordinated care organization has strong connections with other community organizations.
“It gets a little harder when you get into Multnomah County or some of the bigger places,” he said. “There's just a lot more access points.”
Baden said the launch of the new benefits won’t be perfect and that the five-year plan is intended to understand what’s working, grow it in order to show federal authorities that the benefits are valuable. Hopefully, over time they’ll become standard Medicaid benefits, he said.
