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April 28, 2003 Contact: Jim Sellers (503) 945-5738 Program contact: Jim Edge (503) 945-5769 About 10,400 Oregon Health Plan clients to lose coverage on May 1 As a result of failure to pay premiums for March, February or both, about 10,400 low-income Oregon Health Plan clients will be without health-care coverage beginning Thursday. The affected adults are covered by the Health Plan's Standard benefit package, which was instituted Feb. 1 with required premiums and somewhat slimmer benefits. "We are striking a balance between the goal of extending health care to more Oregonians and meeting expectations to operate the Standard plan in a businesslike manner," said Lynn Read, state Medicaid director in the Oregon Department of Human Services (DHS). Notices were mailed April 19 to 19,510 Health Plan clients warning that benefits would end after April 30 if February and March payments were not received by Friday. Earlier, DHS had mailed three billing statements requesting payment. Premiums must be received by the 25th of the month following coverage, or coverage is lost and cannot be reinstated for six months and until past premiums are paid. DHS had mailed similar notices last month to clients who had not paid February premiums, but officials decided not to disqualify non-payers because of administrative issues and client confusion. This one-time exception gave non-paying clients an extra month's grace period. Despite the extra time, about 80 percent of current clients with overdue premiums owe those for February. Monthly premiums range from $6 to $20 per person depending on income and household size. About 100,000 so-called working poor clients were added to the Health Plan in 1994 to extend coverage to people who earned too much for traditional Medicaid coverage but nevertheless fell below the federal poverty level. The future of the Standard benefit package after July 1 is being debated in the Oregon Legislature. DHS bills nearly $850,000 a month in Standard premiums. The Health Plan's Standard benefit package, federally authorized last year with state legislative and gubernatorial support, was designed to look more like private insurance available to other working Oregonians. The Standard plan is different from the Health Plan's Plus package, which is available to 300,000-plus people with mandatory eligibility, in that it lacks coverage for vision and non-medical transportation. On March 1, the Standard plan also eliminated dental coverage, outpatient mental health, outpatient chemical-dependency treatment, and medical equipment and supplies to balance the state budget. Those covered by the Plus benefit package, who pay no premiums, are eligible for coverage because they are aged, blind, disabled, pregnant, children in low-income families, or welfare recipients. For frequently asked questions regarding premiums, click here. |
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