Oregon received federal approval on Wednesday to pilot changes to the state’s Medicaid program over the next 5 years. Under the agreement, Oregon will receive $1.1 billion in federal funds to address inadequate food, housing, and other root-cause issues that lead to poor health for residents and families struggling to make ends meet.
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As part of the agreement, the federal government also approved expanded Oregon Health Plan (OHP) coverage for young children, as well as extended eligibility for youths and adults.
The OHP, Oregon’s Medicaid program, provides comprehensive health coverage to approximately 1.4 million Oregonians, more than 1 in 3 residents. States can request federal approval to test innovations in their Medicaid programs. Wednesday’s agreement between Oregon and CMS renews the state’s current section 1115 Medicaid Demonstration waiver for the next 5 years and provides federal sign-off and funding to implement new changes.
A state must apply for a Medicaid waiver when it wants to make changes from normal federal guidelines. States can request flexibilities in who is eligible for Medicaid, what benefits they receive, and how health care is delivered.
“I’m proud to work alongside Oregon to advance policies to expand access to high-quality health care, particularly for those most in need,” CMS Administrator Chiquita Brooks-LaSure said. “The demonstration invests in the services that people need to address their health-related social needs, such as medically-tailored meals and housing supports. That is transformational change, as are many of the other components included in Oregon’s 1115 demonstration. We encourage all states to follow Oregon’s lead supporting a whole-person approach to care.”
Oregon’s renewed waiver will allow the state to keep children enrolled in Medicaid up to age 6, preventing gaps in coverage that can cause children to lose access to needed care in their formative early years. Oregon is the first state in the nation to receive federal approval for continuous health coverage for children under 6.
All OHP members age 6 and older will have 2 years of continuous OHP enrollment. Establishing longer continuous coverage periods will keep more Oregonians enrolled in OHP with consistent access to health, dental, and behavioral health care.
In another first-in-the nation innovation, Oregon will expand health-related social needs coverage for certain food assistance, housing supports, and other interventions that are medically appropriate for individuals experiencing certain life transitions, including individuals who are homeless or at risk of homelessness.
This package of services, called health-related social needs, includes food and housing supports (including rental assistance) for up to 6 months for groups who have been marginalized such as youths in foster care, people who are homeless, and low-income older adults. State health officials sought federal approval to cover housing and nutritional support services to reduce health inequity and stabilize the circumstances of OHP members who are at-risk of worsening health during major life disruptions. Oregon will provide devices, including air conditioners, air filters, and generators to people with a high-risk clinical need who reside in regions experiencing extreme weather events that place the health and safety of residents in jeopardy as declared by the federal government or the governor.
“Oregon is committed to eliminating health inequity and ensuring that our health care system provides optimal health and well-being for everyone in Oregon,” OHA Director Patrick Allen said. “This agreement gives us more tools and resources to tackle the problems in people’s lives that undermine their health such as lack of housing, food or consistent health coverage. We’re excited to work with partners in every corner of the state to help more people in Oregon live healthier lives, hold down the growth of health care costs and strengthen communities across our state.”
Under the new 5-year Medicaid waiver, Oregon will cover early periodic screening, diagnosis and treatment services for all children and youths up to age 21, and for youths with special health care needs up to age 26, effective Jan. 1st, 2023. Under the new waiver, the federal government will allow Oregon to expand Medicaid eligibility and benefits for youths with special health care needs up to the age of 26 if their income levels are at or below 300% of the federal poverty level. This will ease their transition to adulthood, with fewer disruptions in health care and services.
Oregon also received significant federal support through Designated State Health Programs, totaling $1.1 billion in federal funds over the waiver period. Under the waiver, Oregon will use these funds to address health-related special needs (such as housing, food and climate related supports), increase health coverage, achieve better health outcomes, and improve the efficiency and quality of care.
The new waiver sets a timeline to move Oregon’s prioritized list of services from a demonstration to the state plan as part of standard benefits and services.
Oregon and CMS will continue to discuss the state’s proposals to have new Community Investment Collaboratives throughout the state manage community-led health equity interventions. State and federal health officials also will continue to discuss OHP coverage for youths in detention and adults in jails, as well as 90-day transitional pre-release coverage for adults in prison or psychiatric facilities.
Oregon health officials also requested authority to remove prior authorization requirements for American Indians/Alaska Natives on OHP, convert the Special Diabetes Program for Indians to a Medicaid benefit, reimburse tribal-based practices and extend coverage of new health-related social need services to tribal members not enrolled in a coordinated care organization. Federal officials are continuing to evaluate Oregon’s request.
This press release was provided by Oregon Health Authority.