Oregon Medicaid waiver and redetermination updates


Aaron Kunkler


Three committee bills were introduced, and an update of Medicaid waivers was provided yesterday during the Oregon legislature’s committee days.

The Senate Interim Committee on Health Care met to approve three committee bills. These included LC 32, which would direct the Department of Human Services to create an advisory committee to consult with communities impacted by brain injuries, and to deliver reports to the legislature on services provided. LC 34 would allow for the purchase of Sudafed with a driver’s license. An active ingredient in Sudafed can be used to create meth, and requires documentation when purchased. Allowing a driver’s license to be use could save time for pharmacists. LC 35 would require plans to cover fertility services.


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All three LCs were approved without opposition and introduced as committee bills.

The committee was also briefed on Medicaid waiver renewal and redeterminations by Jeremy Vandehey, director of health policy and analytics for the Oregon Health Authority.

Oregon, like many states, uses the 1115 waiver process established by Medicaid, which allows the state to use federal dollars in ways that aren’t explicitly approved. States can waive certain federal regulations to achieve greater flexibility around Medicaid eligibility, benefits, delivery systems and more. Oregon has had a waiver for decades that allows it to administer benefits in unique ways. Every five years, these waivers must be renegotiated.

In 2012, the waiver process allowed the state to launch coordinated care organizations, which have continued since then. Waivers must prove to be effective, and achieve certain outcomes.

Currently, Vandehey said the state is working on its renewal application. A draft application for formal comment was published in December. The current waiver expires in June, but the federal government is expected to offer an extension through early fall to allow the state to wrap up negotiations.

Oregon is seeking exemptions to focus on four main areas: maximizing coverage through the Oregon Health Plan, improving health outcomes by streamlining transitions and breaking down walls around Medicaid coverage, evolving the global budget, and focusing on targeted investments to increase equity.

Specific proposed changes include providing continuous enrollment for children from birth to the age of five. Children ages six and older will stay automatically enrolled for two years instead of one. Additionally, when people apply for SNAP benefits, the Oregon Health Authority is seeking to enroll them in the state’s health plan automatically if they apply.

Other strategies include providing coverage when people are incarcerated, either in a corrections facility or the Oregon State Hospital or in psychiatric residential treatment. It would also try to define some social determinants of heath that Medicaid funding could be used to address, like housing, transportation, and food assistance.

Oregon, along with each state in the country, will need to being a benefits redetermination process when the Biden administration declares the public health emergency stemming from the COVID-19 pandemic over. States are currently ordered to keep everyone who is covered by the Oregon Health Plan enrolled, and since the pandemic began has added about 300,000 enrollees. Roughly 30% of the state’s population is covered under state insurance.

This state insurance coverage has greatly benefited people living in Oregon, bringing down uninsured rates from 6% to about 4.5% statewide. It has also closed equity gaps. Before the pandemic, about 10% of Black Oregonians were uninsured, a rate which has dropped to roughly 4%. Vandehey expects the state will disenroll roughly 300,000 people.