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DHS news release


August 29, 2005                 


Contact: Jim Sellers (503) 945-5738

Program contact:  Jim Edge (503) 945-5769


Public hearing, meetings set as officials prepare Health Plan change

State officials have scheduled a Sept. 8 public hearing and are conducting meetings with stakeholders as they prepare to ask for federal approval to implement legislatively authorized changes to the Oregon Health Plan.


The benefit changes would limit hospital days and dental coverage and eliminate vision coverage and most over-the-counter drug coverage for various categories of enrollees.


“Although lawmakers provided solid direction for reducing costs they also gave us some flexibility in how we implement changes in benefits,” said Jim Edge, deputy state Medicaid director in the Oregon Department of Human Services (DHS). “By seeking the best ideas available we are continuing the tradition of citizen and professional involvement in making the Oregon Health Plan work.”


Besides holding meetings with a wide range of medical providers, client advocates and other stakeholders, Edge said, a public hearing is scheduled for Sept. 8 in room 50, Oregon State Capitol, 900 Court St. N.E., Salem. Sign-ups will begin at 8 a.m., and the hearing will begin about 8:45 a.m. with presentations about the proposed federal waivers. Interested persons may also submit written comments by Sept. 8 to Mary Reitan at Human Services Building, 500 Summer St., N.E., Salem 97301-1098, or to mary.reitan@state.or.us


Under terms of the state legislation, a request for federal approval of benefit reductions must be submitted this autumn. The state is separately asking for federal


approval of a legislative decision to waive premiums for the poorest 10,800 enrollees in the Health Plan’s Standard benefit package – those who report incomes of 10 percent or less of the federal poverty level – and lengthen premium-payment grace periods for the other 15,000 who continue to pay monthly premiums of $9 to $20. (No premiums are paid for children or by adults enrolled in the Plus benefit package, which covers aged, blind, disabled, children in foster care and people on public assistance.)


Federal waivers are required because the federal government, which pays more than three-fifths of state Medicaid costs, authorized terms of the Oregon Health Plan “demonstration project” that began in 1994.


In meetings with stakeholders and at the public hearing, Edge said these are changes on which the state wants comment:


  • Hospitalization: Limit the number of annual days in medium to large hospitals for adults not covered by one of the managed care plans with which the state contracts. Implement measures to reduce inappropriate hospital emergency-room usage by Health Plan enrollees.
  • Vision: Eliminate payment for routine eye exams, vision therapy, and frames, lenses, contacts and other vision aids for adults enrolled in the Plus benefit package.
  • Dental: Limit covered services for non-pregnant adults enrolled in the Plus benefit package.
  • Pharmacy: Eliminate for all Health Plan recipients payment for most over-the-counter drugs, with some exceptions such as insulin and over-the-counter drugs that are less expensive than comparable prescription medications.


Testimony at the Sept. 8 hearing will be heard by the state Medicaid Advisory Committee and staff from DHS and the state Office for Oregon Health Policy and Research.