OHA releases final policy concept papers for Medicaid waiver renewal

The Oregon Health Authority (OHA) on Tuesday published five final policy concept papers in preparation for its upcoming Medicaid waiver renewal. The concept papers, says OHA, will form the basis of the state’s 1115 waiver application to the Centers for Medicare & Medicaid Services (CMS). The new 5-year waiver will be in effect from 2022–2027.

 

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The concept papers all aim to advance health equity within the Oregon Health Plan (OHP). They include:

  • Maximizing OHP Coverage: Under this policy concept, OHA aims to reduce the state’s uninsured rate from 6% to below 2%. The agency’s other goal is to eliminate current racial and ethnic inequities in the uninsured rates. For example, 12% of Hispanic or Latinx Oregonians are uninsured, compared to just 5% of white residents.

To accomplish these goals, OHA is proposing continuous OHP enrollment for children until their 6th birthday, two-year continuous enrollment for individuals ages 6 and older, and an expedited OHP enrollment path for those who sign up for SNAP benefits.

 

  • Stabilizing transitions to minimize disruptions in care: This concept aims to better support the health of enrollees across life transitions such as changes in institutionalization or natural disasters. It also emphasizes the importance of addressing social determinants of health (SDOH) such as housing, access to healthy foods, and job opportunities.

OHA says it will request to waive federal rules that prevent Medicaid coverage for justice-involved individuals. The agency will ask that Medicaid benefits be retained for youth in the juvenile correction system, and that a limited OHP benefit and CCO enrollment be provided for OHP members in jail, and for those within 90 days of being released from state prison.

OHA will also put in a request for funding with spending authority for SDOH transition services and infrastructure needs.

  

  • Flexible, value-based global budget: The state is requesting authority to create value-based global budgets for CCOs which OHA says will “provide longer-term predictability and flexibility to CCOs and providers, in turn driving additional upstream investments in prevention and health-related services to improve health outcomes and reduce avoidable health care costs.”

The global budgets would “further flip financial incentives” and incentivize CCOs to invest in health outcomes, social determinants, and health equity for members, reads the concept paper.

To achieve these goals, Oregon will request authority to calculate a base budget that is adequate for covered services, to establish a predictable growth rate, and to more closely manage pharmacy costs.

 

  •  Incentivizing equitable care: To more directly focus on equitable care, OHA intends to restructure its Quality Incentive Program by setting up upstream metrics focused on health equity, and adding downstream metrics focused on quality and access measures. This concept paper also states that OHA intends to “redistribute decision-making power among communities.”

 

  •  Focused equity investments: Through this concept paper, OHA intends to call on the federal government to provide an investment in community-driven initiatives aimed at improving the health of those most impacted by inequities. These investments, says the agency, will create downstream cost savings for both the federal government and the state.

To implement the investment, OHA is requesting federal matching funds for SDOH transition services, and authority to count CCO health equity investments as medical claims for rate setting.

 

“OHA is proud of the vision that these policy papers represent – a vision for a more equitable, responsive and community-focused Medicaid system,” said OHA Director Patrick Allen in a statement. “We believe this vision, which we arrived at with extensive community input, will lead to significant improvements in community health, put more resources and decision-making power in the hands of community, and greatly enhance services to individual OHP members in times of need. In short, this is a powerful proposal to the federal government to orient our Medicaid system toward health equity.”

OHA expects to release the draft application on December 1 and begin a formal public comment period on Dec. 7. The feedback will be incorporated into a final application which the agency plans to submit to CMS by February 2022.