|12/7/2016||9:00am - 12:00pm|
Oregon State Library
250 Winter Street, NE
Salem OR 97301
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Medicaid Advisory Committee
The Medicaid Advisory Committee (MAC) is a federally-mandated body which advises the Oregon Health Policy Board (OHPB), the Office for Health Policy and Analytics 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.
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Committee Charter, April 2015
to receive email notification of meetings and updates.
Recent Reports and Documents
Current Policy Work
The Oregon Health Authority (OHA) is uniquely
positioned to work with CCOs and across the agency’s divisions to coordinate
activities to improve oral health outcomes for Oregonians. Recently, OHA
expanded the capacity of its cross-divisional oral health program, with the
hire of its first Dental Director, Bruce Austin (2015). Oregon’s Medicaid
Advisory Committee (MAC) has the opportunity to inform OHA’s ongoing strategic
planning efforts with regard to oral health. OHA is requesting the committee to
recommend a framework for defining and assessing oral health access for
the Oregon Health Plan (OHP). The committee has formed an Oral Health Work Group that will meet July-September to advise the committee who will then submit its recommendations to the Authority in October,
Past Policy Recommendations
Oral Health Access Framework (2016)
Improving access to oral health is critical to ensuring Oregon can meet its Triple Aim for better health, better care, and lower costs in the Oregon Health Plan. In 2016, OHA asked the MAC to develop a framework for defining and assessing oral health access in OHP. The committee formed an Oral Health Work Group made up of oral health experts and key stakeholders, to develop recommendations. The MAC and the Oral Health Work Group prepared and submitted recommendations to the OHA to adopt a standard definition of access, a framework model, and a set of recommended monitoring measures to assess access. The committee further recommends that OHA develop and share a comprehensive implementation strategy, including a communications plan and a strategy to review and update the framework and plan over time.
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.
Oral Health and the Oregon Health Plan (2009)
In 2009, at the request of several stakeholders, the Medicaid Advisory Committee (MAC) reviewed key issues surrounding oral health services and the Oregon Health Plan (OHP). The committee developed a set of comprehensive recommendations and report, which was submitted to the Oregon Department of Human Services. The committee recommended a robust set of policy recommendations, strategies, and set of action steps designed to ensure all Oregonians have access to comprehensive and affordable oral health care.
Healthy Kids Report (2006)
In 2006, at the request of Governor Kulongoski, the Medicaid Advisory Committee (MAC) reviewed key issues in the design of the Healthy Kids program, a plan to cover all Oregonian children up to age 19. The committee developed a set of comprehensive recommendations and report, which was submitted to the Governor. The Legislature passed House Bill 2116 in 2009, authorizing the implementation of the Healthy Kids program.