OR: Medicaid Sign-Up Surge Prompts Two CCOs to Close Enrollment

Tina Edlund, Acting Director, Oregon Health Authority

Tina Edlund, Acting Director, Oregon Health Authority

Four months into Medicaid expansion, two of Oregon’s 16 coordinated care organizations (CCOs) have closed to new enrollment because they’ve gotten unexpectedly high numbers of new patients.

Trillium Community Health Plan, the CCO serving Lane County, closed in mid-March. Debi Farr, Trillium’s spokesperson, said approximately 25,000 people enrolled in the CCO between January and March.

That’s twice the number of new patients Trillium expected to receive in all of 2014. It’s also close to the CCO’s estimate that it would have 27,000 new patients by the end of 2016.

Cascade Health Alliance, the CCO serving Klamath County, is also closed. Its new patient load is double what the CCO expected, said Cascade CEO Bill Guest.

The closures are indicative of how rapidly Medicaid is expanding in Oregon.  Nearly 280,000 people have enrolled in Medicaid, either through Cover Oregon or Oregon’s innovative “fast-track” enrollment process, which is more than half of the 400,000 Oregonians that the Oregon Health Authority estimates are eligible for Medicaid.

The enrollment numbers blow the state’s enrollment projections out of the water. The Oregon Health Authority had estimated that about 136,300 people would join Medicaid in all of 2014.

The doubling or tripling of patient populations has stressed the CCOs’ provider networks, underscoring the growing need for more primary care practitioners.

Guest said that the strain on its provider network is the main reason that Cascade had to close to new enrollees. “We have a limited amount of primary care practitioners in our area,” he said, adding that the requirement to assign patients to primary care providers within 60 days would have become impossible to meet had the CCO remained open.

Farr said Trillium has assigned 13,000 new patients to a primary care provider but is still working to assign the remaining 11,000.

It is affecting which of these new patients can access care, and when.

Tina Edlund, the Oregon Health Authority’s acting director, said that CCOs are required to prioritize patients who need emergency or urgent care. “It might mean the wait time for your first appointment for non-urgent issues, like physicals, are pushed out a little way,” she said.

When CCOs first became operational in 2012, its leaders knew that Medicaid expansion was on the horizon. FamilyCare, Inc., one of the CCOs serving the Portland metropolitan area, has increased the rates it pays its primary care providers as one way to expand its network.

Expanding the use of patient-centered primary care homes and non-traditional healthcare workers are also ways that CCOs are increasing primary care capacity, Edlund points out.

As more of Oregon’s uninsured population enrolls in coverage, it’s unlikely the CCOs’ populations will continue expanding so rapidly in the future, Edlund thinks.

“At some point, this normalizes,” she said. “What’s in front of us right now is the real challenge.”