Oregon has seen a relatively low percentage of residents lose health coverage (compared to other states) since its Medicaid redetermination process began. But health officials there believe the most challenging part of the process is yet to come.
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Vivian Levy, interim deputy Medicaid director for the Oregon Health Authority (OHA), gave an update on the state’s redetermination process during a House Interim Committee on Behavioral Health and Health Care meeting on Friday. The federal public health emergency ended on May 11th, and its continuous coverage provision ended on March 31st.
The OHA began eligibility redeterminations for Oregon Health Plan (OHP, the state’s Medicaid system) members in April. Levy said the OHA has conducted the work with three goals in mind.
“Those are to ensure all people who remain eligible for the OHP remain enrolled in the OHP without any gap in coverage. To ensure that people who aren’t eligible for the OHP any more have the guidance, support, and information to get into another type of coverage so they remain insured. And to make sure that our amazing network of community partners, providers, and (coordinated care organizations) have clear, concise information that is consistent to share with people about what to do and how they can get help.”
The OHA has initiated renewals for 690,714 people, which is about 45 percent of the total OHP population, Levy said. Some of those members are still in the renewal process, while some have completed the process.
About 63 percent (435,421 individuals) of those people were renewed without any additional action needed, Levy said. About 22 percent (151,626 people) received a request to verify some type of information (usually regarding their income). About nine percent received a full renewal packet that they must sign and send back to the OHA. And around six percent (42,308 people) had their benefits terminated.
“About 15,000 of those terminations have happened because people had procedural terminations,” Levy said. “They have not completed the application process.”
Rep. Maxine Dexter (D-Portland) asked how the state’s renewal outcomes look compared to what was projected.
“Right now, I would say things look better than projected. We are seeing a lower number of individuals who have additional information requested, as well as lower numbers of procedural closures than we expected. With that said, we did intentionally set this process up so that the more challenging cases would come in the second half of the process. And so individuals who were likely to lose coverage were in the second part of the process. So we’re not counting our chickens before they’re hatched. We do expect it will get more challenging.”
Dave Baden, interim director at the OHA, said no state is doing more than Oregon to assure residents retain coverage through the redetermination process.
“If you look at what other states are doing in redeterminations, some states have moved six of 10 Medicaid members off,” Baden said. “And we’re (at) less than 10 percent. I think we might go above 10 percent as we go through the second half, but I think that’s just a testament to what we’re trying to do here.”
The process has had some hiccups, however. About 19,000 people who should have received termination notices (because they had not provided information that was requested) instead received approval notices, Levy said.
“So we are going through a process right now of re-triggering all of those requests for information that were not responded to, giving people a second chance to respond to the information that we asked for. [For] anybody who does not respond at the end of this process, we will resend a closure notice and give them that 60-day advance notice again.”
All affected members will keep their medical benefits through the end of the year, Levy said. A contracted call center from Deloitte is reaching out to affected members to explain what happened and notify them of what type of information is needed in order for them to keep their coverage.
The last batch of OHA’s renewals will be due on April 30th, 2024. Those who do not respond to information requests will see their benefits end on June 30th, 2024.
“If they’re no longer eligible, we’ll give them 60 days advance notice before their coverage ends,” Levy said. “And if they come back to us within 90 days after that coverage ends, if they’re still eligible, we can reinstate their coverage without a new application.
OHA and (the Oregon Department of Human Services) are putting together a lot of the materials, and driving a lot of the conversation, but we also work very closely with the state marketplace. And there are a large number of insurance agents who work as community partners and application (assistants) who people can be directed to. So in trying to untangle that insurance web, we do have a lot of folks who do this professionally and also volunteer their time to help walk people through that process. We directly train them and contract with them.”