Experts discuss Oregon’s work to develop new insurance program for low-income individuals who don’t qualify for OHP

Experts discussed Oregon’s efforts to provide health coverage for residents at risk of losing it when the public health emergency (PHE) ends at last month’s 2022 Oregon State of Reform Health Policy Conference.

 

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Sen. Elizabeth Steiner Hayward (D-Portland) is Co-Chair of the Joint Task Force on the Bridge Health Care Program, which has been working to design a new insurance program to cover low-income residents who do not qualify for the Oregon Health Plan (OHP). The Bridge Health Plan would be offered to residents who earn between 138% and 200% of the federal poverty level (FPL). 

Those who have remained on the OHP during the COVID-19 pandemic despite no longer qualifying for it are the program’s biggest targeted population. Through federal policy, the state has not removed anyone from the OHP during the pandemic. But those protections are expected to end whenever the PHE ends.

“We are applying for a modification of our 1115 waiver to allow us to keep people on the OHP who are otherwise eligible for what will be the basic health plan or Bridge Health Plan until it’s up and running,” Steiner Hayward said. “There’s money we put aside already in House Bill 4035 so we’ve got the money to do it. And that’s the right thing to do because what we don’t want is for people to fall off of coverage.”

The task force will work to establish a basic health plan under a 1331 waiver, featuring benefits similar to those offered in the OHP through the plan.

Task force members considered other funding options for the plan, including utilizing a 1332 waiver, before deciding on the 1331 waiver. The 1332 waiver would have allowed for more optionality, as people up to 400% FPL would have been able to choose to opt in or remain in the marketplace. But under the 1331 waiver, everyone in the 138% to 200% FPL category must be included in the plan.

“So even if somebody is currently in the marketplace at 138% to 200%, we think there are about 35,000 people in that category, they will eventually be covered under 1331 under the basic health plan,” Steiner Hayward said.

The decision was made following guidance from CMS, the senator said.

“Optionality is important,” she said. “Under 1332, people could choose to stay in the marketplace. Under 1331, it’s all or nothing. However, CMS told us, ‘Here’s your path. You don’t get a choice.’ So the state’s about to submit a 1115 waiver that will allow people to stay on the [OHP] even if they should be going off into a basic health plan until we get the basic health plan up and running.”

After the basic health plan is created under 1331, the state could consider transitioning to a 1332 plan, which would allow for the creation of a different plan model that would include everybody up to 400% FPL. 

“That’s a choice we will make later,” Steiner Hayward said. “To have a 1332 [waiver work] effectively, however, we have to have a state-based marketplace. That’s going to take us a few years to get there. And it’s another problem altogether, which is another reason why starting with a 1331, for all it’s worth, is the right way to proceed. We have an opportunity to do something that will change the trajectory and keep Oregon’s insurance rate one of the highest in the nation.”

Marty Carty, Government Affairs Director for the Oregon Primary Care Association (OPCA), discussed the initiative’s impact on providers. OPCA supports the state’s 34 community health centers, also known as federally qualified health centers (FQHCs), in trying to achieve health equity. He said 18% of their patient population is uninsured, 68% are publicly insured (through Medicare, Medicaid, or CHIP), and 87% are at or below 200% FPL. 

“We still see a significant number of folks who are uninsured walk through our doors,” Carty said. “We’re hopeful some of those will be eligible for a basic health plan for various reasons.”

Carty said about 41,000 Oregonians who seek care annually at FQHCs fall into the targeted 138% to 200% FPL category. 

“And what the Health Authority and actuarial analysis have told us is that somewhere in the realm of 45,000 to 60,000 adults will likely come over from OHP and be covered under the basic health plan,” Carty said. “We want to make sure everyone who comes over has access to healthcare. In the greater context, though, we’re struggling with this 41,000 number.

How many people are on the health plan today, how many people transfer over, how many people are in the marketplace? It may very well be somewhere around 100,000. It may be more, it may be less. I am cautiously optimistic that we’re right and also, I worry that we’ll really fly in terms of just how many people may be eligible for this.”