Oregon's Medicaid Demonstration
Waiver application draft now available
OHA is accepting comments on its draft waiver with CMS through June 1, 2016
Oregon's Medicaid Demonstration with the Centers for Medicare and Medicaid Services, which allows for Oregon's health system transformation, is in the early stages of the renewal process. A draft of the waiver is available here.
Oregon's vision is to build on the foundation of Oregon's health system transformation. This will include:
- Expanded focus on integration of physical, behavioral, and oral health care through a performance driven system that makes continual improvements to health outcomes and continues to bend the cost curve.
- Focus on social determinants of health and health equity across all low-income, vulnerable Oregonians with the goal of improving population health outcomes.
- Commit to continuing to hold down costs through an integrated budget that grows at a sustainable rate and promotes improved value and outcomes, with additional federal investments at risk for not hitting the target for bending the cost curve..
- Continue to expand the coordinated care model, including innovative strategies for ensuring better outcomes for Medicaid and Medicare dual eligible members.
Public comment will be accepted through June 1, 2016. Please submit public comment via email to Janna.Starr@state.or.us.
Oregon's current waiver with CMS expires June 30, 2017. The renewal would be effective beginning in July 2017.
How to provide input
In writing: Email your comments to Janna.Starr@state.or.us through June 1, 2016
Attend a meeting in-person or remotely:
Stay informed! Subscribe to the Health System Transformation E-Newsletter to hear about what's new with the waiver renewal process.
To request a printed copy of the application or any information in an alternate format, please contact Janna Starr by email at Janna.Starr@state.or.us or by phone at 503-947-1193.
Printed copies will also be available at:>
The Human Services Building, 500 Summer Street NE, Salem, OR
The Portland State Office Building, 800 NE Oregon Street, Portland, OR
Background: Oregon's Medicaid Demonstration
In July 2012, the Centers for Medicaid and Medicare (CMS) approved Oregon's 1115 Medicaid Demonstration that was necessary to implement health system transformation for the Oregon Health Plan. Oregon and CMS hope to continue this work with a wavier renewal.
A very brief summary of the key issues included in the 2012 waiver
- Established Coordinated Care Organizations (CCOs) as the delivery system for Medicaid.
- OHP medical benefits benefit were maintained: There was no reduction to lines covered on the prioritized list.
- Flexibility in use of federal funds: Oregon has ability to use Medicaid dollars for flexible services, such as non-traditional health care workers. All flexible services have to be used for health-related care; however, CCOs have broad flexibility in the array of services necessary to improve care delivery and enrollee health.
- Federal investment of approximately $1.9 billion over five years: (Year 1: $620 million, Year 2: $620 million, Year 3 $290 million, Year 4: $183 million, Year 5: $183M). This funding comes through the Designated State Health Programs (DSHP). See page 73 of the waiver for more information about DSHP.
- Savings: State agreed to reduce per capita medical trend by 2 percentage points by the end of the second year of the waiver. The reduction is from an assumed trend of 5.4% as calculated by OMB and based on the President's budget. Base expenditure is calendar year 2011.
- Strong criteria around quality: CMS want to ensure that cost savings are not realized by either withholding needed care, degrading quality or by cutting payment rates. As such, there is a requirement that CCOs meet a number of quality metrics and that there is a financial incentive for achieving performance benchmarks.
- Transparency: CMS requires assurance that in the interest of advancing transparency and providing Oregon Health Plan enrollees with the information necessary to make informed choices, the state shall make public information about the quality of care provided by a CCO.
- Workforce: The new model of care within CCOs required changes in the health care workforce. Oregon established a loan repayment program for primary care physicians who agree to work in rural or underserved communities in Oregon and training for 300 community health workers by 2015.
In December 2012, Oregon reached another important milestone in its move to reform the health system for Medicaid. The state reached agreement on the Special Terms and Conditions of the July 1115 Medicaid Demonstration, including an unprecedented Accountability Plan and Expenditure Trend Review (beginning on page 161 if the browser does not automatically open to the correct page).
The plan lays out the methods, measurements, and accountability for Oregon's Health System Transformation, including:
- How Oregon will be held accountable for reducing the state's Medicaid expenditure growth trend while improving quality and access;
- Details on the health quality improvement metrics to be used to measure progress. These metrics include a set established by a stakeholder-led Metrics and Scoring Committee that will provide financial incentives for CCOs that show performance improvement.
- How the 2 percentage point reduction in per capita medical expenditure trend will be lowered; and,
- Quality assessments - and the penalties that would occur if health quality were to diminish among the OHP population.
Here is a summary of the main points of the Accountability Plan. You can also watch a recording of an introductory presentation or download a PDF of the presentation.