Oregon Medicaid enrollment sharply down

The Oregon Health Authority may be having operational challenges that are impairing its ability to maintain enrollment for Oregon Health Plan members.

Per OHA published reports, enrollment in March 2016 was 1,076,833.  In January 2017 was 956,790.  That is a reduction in enrollment of 120,043 members in a 10 month time period, equal to an 11% drop in OHP membership.  During that same time period CCO enrollment dropped by 133,322 members.

It is unclear what is causing this shift, but stakeholders are throwing around a few guesses.

  • Economic improvement.  One could argue that an improving economy has generated this drop but that is a very fast decline in membership over a short period of time.  Moreover, the federal Bureau of Labor Statistics shows Oregon’s March 2016 unemployment rate at 4.5%.  The most recent unemployment rate for December 2016 is 4.6%.  So, that rationale for the decline seems a stretch.
  • Re-determination Hold – Due to operational capacity issues, OHA put a hold on the re-determination of eligibility for OHP for several months near the end of 2015 and early 2016.  That meant that nobody lost their coverage as there was a backlog of members needing that re-determination process.  That likely increased membership to an artificially high level.
  • Application Backlog – According to stakeholders, a backlog of applications and re-applications for coverage has existed for well over a year at the OHA.  While the re-determination hold may have increased membership artificially, the time it takes for a member to come onto OHP has been taking a long time.
  • Paper Only Re-Application – OHA has required all re-applications to be done via their paper process.  They’ve cited that re-applications cannot be done in their self-service portal due to bad or missing information from the CoverOregon systems that populated MMIS for these members.  Their goal with paper applications is to ensure that they get good information for members.  They believe they’ll be done with the paper re-application process at the end of March 2017.  At that point everyone can self-serve through their portal.  Late last month they cited a 39,000 paper re-application backlog that still existed.  At the Oregon Health Forum in January, Rep. Mitch Greenlick equated that to a public health crisis since it delayed members access to care.
  • Re-Application Apathy – Organizations provide application assistance across the State of Oregon.  The feedback from the front lines of application assistance efforts, according to stakeholders, is that members who are re-applying didn’t lose coverage because of income but, because they chose not to re-apply.  When asked the standard response is that they didn’t need health coverage when re-application was due.  However, once th member becomes ill and needs coverage, they become motivated to sign up.
  • Too much early enrollment success – Oregon received permission to allow it to enroll beneficiaries onto Medicaid if they were already applying for food stamps.  This may have been a great way to get folks enrolled, but absent the ongoing implementation of that model, it may have created too much success to be maintained through alternate, more traditional enrollment models.

In any case, this reduction in enrollment is likely having significant financial impact on CCOs.  The risk bearing entities were likely planning on maintaining their infrastructure to support a stable enrollment.  Now that the enrollment is changing for reasons that are unclear – and likely unpredicted – it means that CCOs have fewer lives to spread their administrative overhead across and consequently tighter operational and underwriting margins.