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MAC Next Meeting
Selected5/25/20169:30 am - 12:30 pm

​Oregon State Library
250 Winter Street, NE
Room 102
Salem OR 97301


Public listen-in only conference line:  888.398.2342
Access code:  3732275

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2014 - Opening the Oregon Health Plan to more people 

Medicaid Advisory Committee


The Medicaid Advisory Committee (MAC) is a federally-mandated body which advises the Oregon Health Policy Board, the Office for Oregon Health Policy and Research and the Oregon Health Authority on the operation of Oregon’s Medicaid program, including the Oregon Health Plan. The MAC develops policy recommendations at the request of the Governor and the Legislature.

Committee Charter April 2015

Medicaid Advisory Committee end of year report
December 2015

Committee Memo on Basic Health Plan
February 2016


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Medicaid Advisory Committee Churn Report to the Oregon Health Policy Board:

Addressing Churn: Dynamics in Oregon's Insurance Affordability Programs 


Past Policy Recommendations


Policy considerations for 12-month Continuous Eligibility for Adults in the Oregon Health Plan (2015)

A continuous eligibility model serves the aims of the ACA by ensuring consistent, comprehensive coverage for low-income individuals that transition between insurance affordability programs.  Recently, CMS endorsed the use of continuous eligibility for income-eligible Medicaid adults using section 1115 waivers, which Oregon already has for children.  In 2015, the committee explored key policy considerations around 12-month continuous eligibility for income-eligible adults in the Oregon Health Plan (OHP).  The committee prepared and submitted recommendations to the Oregon Health Authority (OHA) regarding the feasibility of this federal policy option, and outlined the potential fiscal impact on the state budget in the next biennium.  The committee recommends that OHA request this policy as part of Oregon's 1115 waiver renewal with CMS in 2017.  The committee also recommends that OHA adopt transparent OHP eligibility, enrollment and redetermination performance indicators; and complete annual assessments of administrative costs that result from churn and potential savings to the Medicaid program, CCOs and health providers if 12-month continuous eligibilty were adopted in the future.

​Exploring Premium Assistance in the Children's Health Insurance Program (2015)
In 2014, the Oregon Legislature passed Senate Bill 1526, charging the Oregon Health Authority (OHA) with examining the feasibility of using Children’s Health Insurance Program (CHIP) federal matching funds to subsidize commercial insurance for children in families with incomes between 200-300% of the federal poverty level (FPL), commonly referred to as premium assistance. The MAC was asked by OHA to examine this issue and review the structure of Oregon’s existing CHIP program, federal and state regulations pertaining to CHIP and premium assistance, and potential impact to individual CHIP members and their families in terms of access and continuity of care, benefits, affordability and whole family coverage. Based on the committee’s work, it advised the OHA that a premium assistance program for Oregon’s CHIP population is not feasible at this time and that the state reassess opportunities to improve Oregon’s CHIP program in the future. In January 2015, the committee submitted its recommendation in a memo to OHA. The committee’s memo was included in OHA’s report submitted to the Oregon Legislature in February 2015.  

Options to Mitigate the Impact of Churn between Medicaid and Qualified Health Plans in the Exchange (2014)
The Affordable Care Act (ACA) is increasing the number of insured Oregonians through two primary strategies - expanding Medicaid and providing insurance through state-based insurance exchanges.  As an individual's household income exceeds the maximum for Medicaid eligibility, he or she will be eligible for subsidies to buy coverage through an exchange, up to a household income of 400 percent of the federal poverty level (FPL).  This switch in eligibility also works in reverse.  If an individual's household income reduces below 138% FPL, he or she will become eligible for Medicaid.  A key design challenge for those tasked with implementing the reform law is how to manage this "churning" phenomenon - when individuals cycle in and out of public programs as their income fluctuates - so that care is not interrupted.  To address this issue, the Medicaid Advisory Committee examined the issue and considered policy options intended to promote continuity of coverage for individuals and families enrolled in the Oregon Health Plan (OHP) and qualified health plans in the Exchange. In August 2014, the committee submitted a comprehensive report and set of recommendations to the Health Policy Board for options to reduce, avoid, and mitigate future churn between these two programs.

Person-and Family-Centered Care in Oregon (2013)
The committee developed and put forth a set of strategies and actions to enhance person-and family-centered Care in Oregon for individuals enrolled in the Oregon Health Plan (OHP).  The guiding principle for the Committee's work is to improve person-and family-centeredness across the continuum of care for current and future OHP members.  Each strategy is accompanied by a set of actions that will lead to more person-and family-centered models of care, contribute to a high-value health care system and work to support Oregon's three-part aim for individuals served by the OHP.  The MAC submitted its recommendations to the Oregon Health Policy Board on July 2nd, 2013.​ 

Oregon Medicaid EHB Benchmark Plan (2012)
The federal Affordable Care Act (ACA) established new requirements beginning in January 2014 for benefits covering Medicaid expansion populations, such as those currently covered under Oregon Health Plan (OHP) Standard. The Affordable Care Act requires states to offer a comprehensive package of items and services known as “essential health benefits” (EHB). From August through November 2012, the Oregon Medicaid Advisory Committee worked to select a benefit package that will meet all 10 federally required essential health benefits and meet the benchmark selection criteria. In December 2012, the committee recommended the Oregon Health Plan Plus (*for non-pregnant adults) as the basis for the state’s Medicaid benchmark plan. This decision was based on a set of decision-making principles adopted by the committee and a desire to simplify, align, and streamline benefit coverage across the Oregon Health Plan (i.e., OHP Plus vs. OHP Standard). The recommendation also seeks to minimize disruption for individuals who move among different benefit packages within OHP. On January 8, 2013, the Oregon Health Policy Board moved to approve the MAC’s final recommendation

Behavioral Health Integration (2009)
In response to the health disparities that exist among populations that experience mental health or addictions problems, the Medicaid Advisory Committee (MAC) reviewed key issues surrounding integration of physical, behavioral, and oral health services within the Oregon Health Plan (OHP) between February and June 2009. The MAC heard testimony from mental health and substance abuse consumer advocates, providers, state program administrators, and other stakeholders. These presentations, written testimony submitted to the MAC, and available research guided the Committee in developing recommendations for integrating behavioral and physical health care. The MAC submitted its recommendations to the Director of the Department of Human Services/Director-Designee of the Oregon Health Authority August 17, 2009. These recommendations supported increased collaboration with other public and private groups, including the Oregon Health Authority, with the intent to achieve behavioral health integration and improved health outcomes for all Oregonians. 

Oral Health Access (2008)
Between June and November 2008, the Medicaid Advisory Committee (MAC) discussed oral health access issues and gathered input from 13 interested groups and stakeholders including: the Division of Medical Assistance Programs representatives, consumer advocates, dental insurance plans and Dental Care Organizations, Oregon Health Plan Fully-Capitated Health Plans, Department of Human Services Public Health, Oregon Office of Rural Health, Oregon Child Development Coalition (Head Start focused), a rural practicing dentist, Oregon Dental Association, Oregon Dental Hygienists’ Association, and the Oregon Board of Dentistry. The Committee was also given research on state level, dental health status vital statistics, primary care dental capacity, and a national report on oral health access. Feedback from these groups, as well as, available research helped to inform a set of committee recommendations submitted to the Director of the Oregon Department of Human Services on March 31, 2009. 

Covering Kids (2006)
In February 2006, Governor Kulongoski requested that the Medicaid Advisory Committee work with the Oregon Health Policy Commission and the Health Services Commission to produce a set of policy recommendations for maximizing new and existing resources to ensure that all of Oregon's children have access to health care. These recommendations were intended to support the development of the Governor's 2007-2009 recommended budget and the development of Oregon's revised Medicaid demonstration waivers. The MAC held community meetings across Oregon in April and May to talk with stakeholders and citizens about the best way to improve children's access to health care services. The Committee submitted its recommendations to the Governor's Office on May 18, 2006 and worked with the Oregon Health Policy Commission and the Health Services Commission to inform these bodies in development of recommendations for improved access to health care for all Oregonians.