OHA reassigns Oregon Health Plan members in 5 counties to new coordinated care organizations for 2020 to preserve access to care
Oregon Health Plan (OHP) members in 5 counties will be reassigned to different coordinated care organizations (CCOs), when new contracts for Medicaid health plans begin on January 1, 2020. The Oregon Health Authority (OHA) is moving members because the CCOs to which some OHP members were originally assigned (or members had chosen during the current member choice period) do not have health care provider contracts in place to serve them.
The changes include:
- Clackamas, Multnomah and Washington counties: Trillium Community Health Plan will be ineligible to enroll members until at least April 1, 2020. All members currently slated to be enrolled in Trillium beginning January 1, 2020 (approximately 40,000 members) will be reassigned to Health Share of Oregon, the other CCO that is contracted to operate in the tri-counties at the start of 2020. The Oregon Health Authority is taking this action because Trillium Community Health Plan does not have a hospital in its provider network.
- On November 8, 2019, the Oregon Health Authority notified Trillium Community Health Plan that the CCO will have until June 30, 2020 to contract with a hospital and meet other network requirements. If not, the CCO would lose its ability to serve the tri-county region over the next 5 years.
- Jackson County: More than 10,000 members of AllCare CCO will be reassigned to Jackson Care Connect CCO, starting January 1, 2020. Members will be shifted between CCOs to preserve their current provider relationships: the provider network that currently serves the AllCare members affected by this change will no longer have a primary care contract with AllCare at the start of the new year, but will continue to contract with Jackson Care Connect. AllCare will retain OHP members who are served by other providers in Jackson County.
- Lane County: Members of Trillium Community Health Plan who are served by a primary care provider network, which will no longer have a contract with the CCO in 2020, will be moved to Pacific Source of Lane County. The move is effective January 1, 2020. This change will ensure members continue to have access to their current providers. Trillium will continue to serve other OHP members in Lane County who are not affected by this change in Trillium’s Lane county network.
OHA will notify all affected members of changes in their enrollment in coming weeks, before new CCO contracts take effect on January 1, 2020.
OHA Director Patrick Allen said, “Our top priority during the transition to new CCO contracts has been to make sure OHP members continue to have access to high-quality, well-coordinated health care. OHP members depend on their CCOs to offer the doctors, counselors and other providers they need to ensure health and well-being for themselves, their families and their communities. We are doing everything we can to make sure nothing disrupts those vital provider relationships.”
On July 9, 2019, the Oregon Health Authority (OHA) announced its intent to award 15 organizations contracts to serve as coordinated care organizations (CCOs) for the Oregon Health Plan’s nearly 1 million members. CCOs have been undergoing “readiness review,” which includes examination of their updated provider networks, since the summer. CCOs signed new contracts, totaling more than $6 billion for the 2020 contract year, prior to October 1, 2020. Contracts remain contingent on successful completion of the readiness review process.
This press release was provided by the Oregon Health Authority.