Enrollment in the Oregon Health Plan just keeps growing.
The number of Oregonians in the taxpayer-funded system topped 1.28 million as of late March, up more than 200,000 since the start of the COVID-19 pandemic a year ago, .
For the time being, the federal government, under emergency legislation, is sending enough extra Medicaid money Oregon’s way to cover the added cost of those new members, the state says. But for the coming state biennium, starting July 1, the flow of federal cash may not be sufficient to cover the added burden.
“For the next biennium, we are anticipating that the higher Medicaid match will not be enough to cover the higher caseload, but we don’t have a final estimate yet,” Lori Coyner, the Oregon Health Authority’s Medicaid director, told The Lund Report. “The caseload forecast is currently being developed, and we hope to have a budget impact priced in April.”
Each member covered by the Oregon Health Plan, Oregon’s version of Medicaid, costs the state about $6,000 a year. About 75% is covered by the federal government, with the rest coming from the state. At 1.28 million members, OHP is now insuring 30% of Oregon’s population.
The expansion is being driven by the economic fallout of the COVID-19 crisis – waves of job losses -- and the federal reaction – giving states extra money to cover swelling Medicaid rolls. That money comes with a condition that for the duration of the public health emergency states don’t boot members who fail to meet income and other limitations off the rolls.
The result: An unknown number of Oregonians on the Oregon Health Plan earn more than the top limit -- that’s $1,468 a month for a single person, for example -- or don’t meet other requirements.
But as the pandemic recedes, the Oregon Health Authority, which runs the Oregon Health Plan, may find itself having to remove these people from the plan.
Once the federal government declares an end to the nationwide public health emergency, Oregon will begin notifying Medicaid members who may no longer be eligible for the free insurance,and ask them for income or other verification, Coyner said.
“We will undertake any such process with great care and deliberation, closely following the (federal) guidance and/or rules,” Coyner said. “Our state is committed to helping all those who need health care coverage to be able to access it in a timely and sustainable way. We will continue to take that stance moving forward, including after the COVID-19 crisis ends.”
Just when the federal government will declare the public health emergency over is unclear.
The federal Health and Human Services Administration in February told states that it will “likely” keep the emergency declaration in place until the end of the year. Also, the agency said it would give 60 days’ notice prior to ending the emergency.
And as long as the emergency is in place, the federal government will likely keep channeling the extra Medicaid money to states.
After the Trump administration in January 2020 declared the emergency, Congress passed the Families First Coronavirus Response Act, which boosted by 6.2% the amount of Medicaid money states were to receive until the emergency was over.
That extra money has been key to states handling the surge of Medicaid enrollees, who lost their jobs and their commercial health insurance in the initial waves of the pandemic. Oregon’s Medicaid enrollment is up nearly 19% since the pandemic’s onset.
In the 2021 calendar year, states will get about $44.5 billion of this extra Medicaid money, including about $22.5 billion for the July through December period, according to the Center On Budget and Policy Priorities, a Washington, D.C.-based nonprofit think tank. The extra money “should help states avert unnecessary, potentially damaging cuts as they craft their budgets for the coming year,” wrote Jennifer Sullivan, the center’s director of housing and health, in a recent article on the legislation.
The center estimates that under the emergency legislation, Oregon will receive an extra $580 million in Medicaid money for this calendar year. Coyner told The Lund Report it has not finalized its estimates for 2021.
The state is receiving $307 million in extra money for 2020, Coyner said.
Those funds come on top of the roughly $7 billion a year the federal government sends to Oregon to cover the standard federal share of Medicaid spending.
The federal government, unlike the states, isn’t bound by balanced budget requirements, Sullivan noted.
The federal government has been running deep into the red since COVID-19 hit, in part because of its many financial bailout efforts, including Medicaid spending.
The extra Medicaid spending has “ensured that Medicaid remains available to those who need it, including millions of workers in essential or frontline industries,” Sullivan wrote.
Under the Families First legislation, states that accept the extra aid can’t terminate Medicaid enrollees except in very limited circumstances: death, incarceration, out of state residency, or voluntary termination. That means, for example, that an enrollee’s income could increase beyond Medicaid limits, but the enrollee could continue to get the coverage. Also, during the emergency, people who sign up for Medicaid can “self-attest” that they are eligible, rather than having to provide proof, for example of income. Federal stimulus payments and increased unemployment payments do not count toward income, under the emergency legislation.
Even as the state looks to trimming back Medicaid rolls, Gov. Kate Brown has called for expanding Medicaid to cover undocumented immigrants. Brown has proposed allocating $10 million for the pilot project, enough to cover about 2,000 undocumented adults for one year.
You can reach Christian Wihtol at [email protected].
It is quite commonly reported, the way this article does: " Each member covered by the Oregon Health Plan, Oregon’s version of Medicaid... " Oregon, like other states, uses Medicaid for other programs, most notably Long Term Care. Perhaps an article making that distinction in the future would be worthwhile.