Oregon health officials are utilizing new initiatives to help people at risk of losing Medicaid coverage retain their eligibility during the state’s redetermination process.
The federal public health emergency ended on May 11th, and its continuous Medicaid coverage provision ended on March 31st. The Oregon Health Authority began eligibility redeterminations for Oregon Health Plan (OHP, the state’s Medicaid program) members in April. Vivian Levy, interim Medicaid director at OHA, discussed the process at the 2023 Oregon State of Reform Health Policy Conference.
OHA has initiated redeterminations for about 60 percent of the total number of people who need to go through the process, Levy said.
“We are in the top five in the country in terms of states that have retained individuals on coverage,” Levy said. “We do expect that we are going to see more people lose coverage in the second half of the unwinding process because of how we have sequenced all of our various households who have OHP to go through this process. But as of right now, compared to many other states, we have retained a large number of folks who previously had OHP on the rolls.”
About 62 percent of Oregonians found to be eligible retained their coverage without OHA having to acquire additional information, Levy said. Requests were sent to about 20 percent of them to provide additional information, with pay stubs being the most common type requested. OHA has been using verification information from programs like the Supplemental Nutrition Assistance Program to help people retain eligibility.
Oregon also has the third-lowest rate of procedural disenrollments at 33 percent, according to KFF. It trails only Illinois (14 percent) and Maine (30 percent).
OHA has been utilizing a temporary Medicaid program it requested through a 1115 waiver to provide coverage for people who have an income level of 139 to 200 percent of the federal poverty level (FPL).
“Those are folks who will be eligible for the Basic Health Program (BHP) when it launches next year,” Levy said. “We know that most people in this income group are most likely to be without insurance.”
The BHP will cover adults who earn up to 200 percent of FPL who don’t have other health coverage available to them, Levy said.
“Individuals who are over the standard Medicaid limit of 138 percent FPL would normally move into marketplace coverage. But that is the income bracket who is least likely to move into marketplace coverage, to have the ability to shoulder any kind of cost sharing. So far, as we’ve gone through the redetermination process, between 12,000 and 14,000 people have been found eligible for that temporary Medicaid program. They will stay in that program until the BHP is stood up in the summer. At (that) point we will redetermine those folks and move them out of that program and into the BHP.”
— Levy
OHA has also been maintaining continuous eligibility for some individuals. When kids up to age six are found to be eligible during the unwind, they receive continuous eligibility.
“Meaning if their circumstances change, they will remain covered,” Levy said. “People six and older have two years of eligibility moving forward. We started applying that in July. Many people have been found eligible, and have that extended period of eligibility. We have not had real continuous eligibility outside of the pandemic in Oregon since OHP standard [was in place] a long time ago. And that was not full coverage. So this is a huge change for adults in the Medicaid program.”
CareOregon COO Amy Dowd said the insurance agency has been collaborating with OHA, community organizations, and other partners during redeterminations.
“Unlike any other event we’ve experienced in the Medicaid space, this one is complex, (with) members understanding their coverage options after perhaps not thinking about their coverage after an extended period of time,” Dowd said.
Dowd said CareOregon is grateful that OHA allowed coordinated care organizations to support redetermination efforts through the direct funding of OHP assister positions. CareOregon has also been able to provide grant money for organizations performing general outreach to OHP members.
“We ensured that we were supporting grants with a network of culturally and linguistically diverse partners. The first round of our grants was in June. We also offered assistance with the application process, if needed.”
— Dowd
CareOregon has awarded over $2 million in grants ranging from between $15,000 and $120,000 to 67 organizations across the state, Dowd said.
Omar Al Rais, vice president of operations at Project Access NOW, said the organization’s team of certified assisters represents the communities they’re serving in many ways.
“[They’re] conducting outreach, helping them navigate the process of redetermination, and explaining what types of letters they’re receiving in a culturally responsive and linguistically appropriate manner,” Al Rais said. “For those that are not eligible after redetermination, we help them enroll in a qualified market plan.”
Ultimately, 1.5 million people will go through the redetermination process in Oregon, Levy said.
“OHA has a commitment to the elimination of health disparities by 2030, and one of the foundational elements of that is achieving a high insurance rate and a high coverage rate for as many people in the state as possible,” she said. “So we have that basis for people to be able to access the care and benefits they need.”
Dowd said CareOregon is attempting to learn more about the demographics of people who tend to be less responsive to the process in order to better reach them. That includes people who are houseless, over 65, use long-term services, and Asian/Native Hawaiian Pacific Islanders.
“Those are folks we know we have to prioritize outreach (to) in this next stretch,” Dowd said.