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DHS news release

June 8, 2004

Contact: Jim Sellers (503) 945-5738
Program contact: Cindy Becker (503) 945-5944

Health Plan's Standard benefit package closes to new enrollments July 1


The Oregon Health Plan's Standard benefit package will be closed to new enrollment beginning July 1, as officials begin to scale back the plan in response to budget limitations.

The Standard plan currently covers about 50,000 Oregonians. This figure must be reduced by more than half by June 30, 2005, to be sustainable with available dollars, according to the Oregon Department of Human Services (DHS).

In addition to the suspension of new enrollments, reaching this goal will likely require stricter income eligibility requirements as plan participants reach the end of their six-month enrollment periods and reapply.

State general-fund dollars are being withdrawn from the Standard plan under a budget-balancing plan that the legislative Emergency Board approved in April, in response to the Feb. 3 defeat of Measure 30.

"I am pleased with the cooperation we are getting from the federal government and from our partners who deliver benefits through the Oregon Health Plan," DHS Director Gary Weeks said. "This teamwork should permit us to provide a high level of service to those whom the Standard benefit package continues to cover."

The 2003 Legislature approved two taxes -- one on Medicaid managed care plans and one on hospitals -- to help fund the Standard plan.

The managed care tax has received the required approval from the federal Centers for Medicare and Medicaid Services; a request for approval of the hospital tax is pending. Each dollar from the taxes will be matched with $1.50 in federal Medicaid money to fund the Standard plan. However, these revenues will not fund the plan at its current level.

Notices of the closure to new enrollments are being mailed today to people currently on the Standard plan -- low-income adults who don't qualify for traditional Medicaid.

"We are advising people already on the Standard plan that for now, they can keep their eligibility by paying their premiums on time, and by reapplying timely when they are notified that their six-month eligibility is about to end," said Lynn Read, state Medicaid director for DHS. "We will provide additional notice to participants if we need to make changes in Standard eligibility."

Department officials are still reviewing projections to determine what changes to eligibility may be necessary to reduce the plan's expenses to a sustainable level.

Currently, participants must have an income below 100 percent of the federal poverty level, or $1,041 a month for a family of two.

Pending the necessary federal approvals, it is anticipated that the remaining covered population would receive a benefit package covering doctor visits, prescription drugs, outpatient mental-health and chemical-dependency treatment, emergency dental, lab, x-ray, medical supplies and a limited hospital benefit.

The nearly 300,000 people covered by the Health Plan's Plus package are entitled to coverage under federal Medicaid law and aren't affected by the changes. The Plus package is available to foster children and to people who are aged, blind, disabled or on public assistance.