Waiver Delayed but not in Trouble

Saxton says CMS may offer additional financial support beyond the $1.25 billion request.

Oregon’s federal waiver to keep the Oregon Health Plan alive another five years remains on track, with continued discussions between the Centers for Medicare & Medicaid Services, but the waiver won’t be approved by December, despite efforts by the Oregon Health Authority.

“There’s too many things going on with politics at the federal level,” Leslie Clement, director of policy at the OHA, told the Health Policy Board. “We may get the waiver extended [it runs out June 30, 2017] but I’m not worried about losing the waiver. CMS may okay some aspects earlier.”

In other good news, CMS may offer additional financial support, above and beyond the $1.25 billion, which could offset the potential budget deficit next biennium. “But we can’t bank on that,” said Lynne Saxton, director of the OHA, who didn’t offer any specifics.

The Oregon Health Plan population has also dipped below the 1.1 million mark, with the coordinated care organizations feeling the pain of fewer members which translates into fewer dollars.

Total enrollment has dropped from 1.15 million to 1.02 million, according to OHA spokespeople, and from 1.07 million to 980,000 for the population that only receives emergency services. That decrease was caused by technology upgrades that improved the renewal process, the agency insisted.

“The current forecast for the Medicaid population is relatively flat for the next biennium, and we do not expect membership to drop below 1 million. We continue to update our forecasts as new data is received,” the agency said.

But CCO executives contend those reductions occurred because the re-determination process that determines whether someone remains eligible had not been enforced following the collapse of Cover Oregon, and was reinstated last April by the federal government. 

OHA spokeswoman Michelle McClellan acknowledged Oregon had permission from the feds to hold off on re-determination, but said the waiver did not end in April. Since then, CMS has given the state authority to extend the dates for renewals scheduled for January-July 2015 for up to five months, until May 2015 through October 2015. And, extend the dates for renewals scheduled for November 2015 through May 2016 for up to three months, with all renewals scheduled during that period to be completed by June 2016.

Meanwhile, the new waiver calls for $1.25 billion for community health collaboratives, which will help the state go after the social determinants of health, such as stable housing and behavioral health.

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