Stakeholders discussed the plethora of benefits Oregon’s Medicaid 1115 Demonstration Waiver will provide for members, including landmark climate-related services, at the 2023 Oregon State of Reform Health Policy Conference.
The Centers for Medicare and Medicaid Services (CMS) approved changes to the state’s Medicaid program last year. The waiver will provide $1.1 billion in federal funding to address social health needs and expand Oregon Health Plan (OHP) coverage over the next five years.
Stephanie Jarem, director of the Office of Health Policy at the Oregon Health Authority (OHA), said Oregon applied for the waiver in order to make Medicaid coverage more equitable and provide better health outcomes for members.
“That allows us to change benefits, expand Medicaid to other people, (and) pay differently,” Jarem said. “Those are all things Oregon has done successfully in our waiver applications throughout the years, starting in 1994.”
CMS approved Oregon’s request for health-related social needs services related to climate change (like heat or cold events, snowstorms, or fires) recovery devices like air filtration devices/purifiers and air conditioning (AC) units, Jarem said. Those are predicted to be available to OHP members in March.
Dr. Amy Burns, vice president of benefit management and pharmacy services at AllCare, said coordinated care organizations (CCOs) are in a good position to begin rolling out climate-related services.
“We’ve done a lot of work to do this benefit already as flex services,” Burns said. “Air filtration devices—air conditioners, heaters, other medically-necessary devices—are something that we’ve been mobilized to dispense to our members over the last few years. So I think there’s a lot of groundwork that’s been laid on how we can identify our members who are eligible and how we can procure and dispense the devices.”
CCOs have been working with OHA a lot to determine what the rollout of the initiative will look like, Burns said.
“We’re building it as we go,” she said. “One of the requirements for CCOs is to identify members who are eligible and do outreach to them, as well as providers in the community. We’re at a pretty good position to start.”
Alyssa Craigie, director of health systems integration at Health Share of Oregon, said the organization is very conscious of managing expectations for the benefit.
“Not only do you have to qualify for the device itself—have a housing or social need that indicates you would benefit from a climate device—but you also have to meet a set of clinical conditions. So Health Share has worked with our public health clinical leadership, as well as our clinical advisory panel, to develop a dashboard so we can see—based on the type of device—what clinical conditions are most relevant and would indicate that somebody would benefit from having access to that device. And managing expectations in the community to make sure there’s a full understanding that it’s not just everybody that gets an air conditioner.”
— Craigie
Jake Arrastia, senior director of innovation and integration at Central City Concern, said there are concerns about what might happen when everyone on a particular property gets AC services, however.
“We don’t account for (an) increase in electric costs when everyone on the property has AC,” Arrastia said. “We don’t account for any type of damage repair when a service request comes in. Although it’s exciting that you’re creating a more stable environment for the member, there is fear on the operational side, particularly on the budget side of it. We haven’t grappled with how we’re going to tackle that yet. But overall, we think it’s going to be good for the clients.”
The waiver also includes housing benefits for those at risk of becoming homeless, which will begin in November next year, Jarem said.
“The housing benefits that are available are rental assistance or temporary housing for up to six months, utility assistance for up to six months, pre-tenancy support services, and housing-focused navigation or case management. In terms of the six-month limit, we certainly hoped it would be more. We went in hoping for a year. CMS did not agree with that. We’re trying to focus on the fact that this is pretty incredible to have six months of Medicaid. It’s an acknowledgement that housing is health.”
— Jarem
DeAnn Carr, senior director of community and behavioral health systems at Yamhill Community Care, said the housing initiative and its implementation is likely the most vulnerable aspect of the waiver, considering its moving parts and limited resources.
“We’re going to need to approach this through the lens of a five-to-10 year plan,” Carr said. “It’s a different sort of beast to wrestle, but it’s a very critical one. If we can’t come together with that shared consensus on longevity and how to roll it out, we can cause it to implode as friction between partners comes into play. If I expect it to be delivered in a year, and somebody else is expecting it in five years, that creates vulnerability. We need to have requirements that reflect the now.”
Nutrition benefits tied to the waiver will become available in January 2025, Jarem said. The waiver will also allow for expansions of coverage, including continuous enrollment for children up to age six and two years of continuous enrollment for everyone above age six. Both of those benefits began in July. An expansion of coverage for Oregonians up to age 26 with special healthcare needs will launch in January 2025.
“All of these waiver changes are in line with innovation [steps] the state has always taken,” Jarem said. “Our hope is we’re going to be ending up with better health outcomes, more equitable coverage throughout the state, and avoiding costly changes in care for members.”