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DHS news release

June 8, 2004

Contact:Jim Sellers (503) 945-5738
Program contact: Jim Edge (503) 945-5769

Medical co-pays for Health Plan's Standard clients to end June 19


Oregon Health Plan officials are mailing special notices to about 50,700 adults covered by the Standard benefit package telling them that they will no longer be expected to make co-payments for medical services beginning June 19.

The action results from a May 20 ruling by Oregon District Court Judge Garr M. King that said although a federal agency had approved the co-payments, the practice was contrary to federal law.

Ranging from $2 for certain prescriptions and $5 for an office visit to $250 for hospital admissions, OHP-Standard clients have been charged these co-payments since Feb. 1, 2003.

Meanwhile, King upheld the state's right to charge monthly premiums of $6 to $20 for persons covered by the Standard benefit package. Standard clients are adults whose incomes are below the federal poverty level ($1,041 a month for a household of two). The state began providing services to them with the 1994 inception of the Oregon Health Plan.

The state is amending contracts with managed-care insurance plans to increase their monthly reimbursement rates to reflect lost revenue resulting from an end to co-payments, said Lynn Read, state Medicaid director in the Oregon Department of Human Services. She said actuaries are figuring the amounts.

The judge's ruling does not affect about 304,000 people covered by the Health Plan's Plus benefit package for people who are federally entitled to Medicaid coverage because they are on public assistance, children in foster care, or are blind, disabled or aged. Many of these people make co-payments of $2 and $3 for selected medical services but, unlike persons in the Standard population, cannot be denied subsequent medical services after a failure to pay. Clients receiving the Plus package pay no premiums.

The lawsuit, Elizabeth A. Spry and others versus the state and federal governments, was filed by the Oregon Law Center on behalf of persons covered by the Standard benefit package. The judge ordered the state to discontinue co-payments 30 days from the date of his ruling.