Q. What is OHP Standard?
A. The Oregon Health Plan (OHP) Standard program provides no-cost or low-cost health coverage to uninsured adult Oregon residents who:
- Are ages 19 and older;
- Are not pregnant;
- Are not on Medicare, and;
- Are very low income.
The OHP Standard program is paid for by a hospital tax and matching federal dollars.
Q. What is the OHP Standard drawing list?
A. People interested in applying for OHP Standard benefits must first place their names on the drawing list. The program has a limited number of spaces available based on funding and names are drawn as openings become available.
Q. Why is a drawing list necessary?
A. Unfortunately, there is not enough money to cover all the people who need health care coverage and meet the qualifications for OHP Standard. Therefore, the Oregon Health Authority (OHA) uses this list to give everyone who wants to enroll in OHP Standard an equal opportunity to get on the drawing list and have their name randomly drawn from the list to receive an OHP application.
Q. Why use a random selection process? Why not consider people's health issues or use some other method to pull names from the drawing list?
A. The department chose a random selection process because it gives everyone an equal opportunity to have their name selected from the list. OHA looked at several options when creating the drawing process, including:
- Adding people to OHP Standard based on health status. Federal law prevents states from determining eligibility for federal programs based on health care conditions; therefore, it is unlikely that they would approve this approach for a drawing list.
- OHA also wrestled with prioritizing health status. Determining what's more egregious and what's the highest priority would be difficult. Even if consensus could be reached, OHA couldn't get past the federal government's certain disapproval of the idea.
- OHA also looked at selecting names on a 'first-come, first-served' basis, but rejected the option because it puts people without ready access to the information or the means to get on the list at a disadvantage.
In developing the OHP Standard drawing plan, OHA actively sought input from community stakeholders and the public about the drawing process. To do this, OHA assembled a group of stakeholders to review the drawing list plan, discuss concerns, evaluate options and make recommendations. Ultimately, the department and workgroup determined that using a random selection process was the fairest way to give people the opportunity to apply for OHP Standard.
Q. When did the drawing list open?
A. The list officially opened November 1, 2009. However, due to intense public interest OHA chose to begin accepting requests October 21, 2009.
Q. What about people who signed up for the previous (2008) drawing list?
A. The department sent a letter to those people who were on the original drawing list and haven't had their names drawn. The letter instructed them to respond if they wanted to be on the 2009-2010 drawing list.
Q. Can people who do not have a home address get on the drawing list?
A. Yes. The department only asks for a mailing address in order to send an application if the person's name is selected. People can use the address of a friend, relative or organization that has agreed to receive the application for them.
Q. How will I know if OHA has received my request to be on the OHP Standard drawing list?
A. OHA will mail you a letter with your drawing entry number. Remember, this only means that you are on the list, it does not guarantee you will receive an OHP Standard application. Also remember, your drawing number does not identify your place on the list. Names will be drawn from the drawing list at random.
Q. How often will names be drawn and applications mailed out?
A. OHA will randomly draw names and mail applications, on a regular basis, until OHP Standard projected capacity is reached.
Q. What if I send in an OHP application without being on the OHP Standard drawing list?
A. Staff will process your application for eligibility for other programs, but not for OHP Standard. You must sign up on the drawing list to be considered for an application for OHP Standard.
Q. What about people who don't qualify for OHP Standard, like pregnant women and people under 19?
A. Pregnant women and other adults may be eligible for the comprehensive OHP Plus benefit package. The OHP Plus benefit package is open for new enrollment. People can apply for it at any time. Children may qualify today for the Oregon Healthy Kids plan with no waiting. To see if you or anyone in your household is eligible for a program other than OHP Standard, you must complete an OHP application..
Q. What about non-citizens who don't qualify for OHP Standard?
A. Federal law requires Oregon to provide emergent medical services to non-citizens who otherwise meet Medicaid eligibility rules, including income and resources requirements. To see if you or anyone in your household qualifies for emergent medical services, you must complete an OHP application.
Q. What if I don't know if I qualify for DHS medical assistance?
A. You can put your name on the drawing list and still fill out the OHP application. OHA will process the application and let you know if you qualify for any DHS medical assistance programs. To apply:
- Request an application by phone at 1-800-359-9517, 711 (TTY); or
- Pick up an application at a local DHS branch office - for locations, call 1-800-699-9075, 711 (TTY); or
- Complete the online application at https://apps.state.or.us/mbs
Q. Why expand the OHP Standard program now?
A. With the tough economic times, demand for services by Oregonians from OHA has increased dramatically. Economic issues have also forced OHA to make some hard decisions in order to stay within its allocated budget. This has required some services to be reduced or eliminated.
With proposed cuts to services, it seems an unlikely time to be increasing the number of Oregonians in the Oregon Health Plan Standard program or to be conducting outreach and marketing for the program. However, the greater demand for services makes it necessary to increase awareness and ensure people who qualify for these services receive them.
Q. How is the OHP Standard program expansion possible?
A. In 2009, Oregon House Bill 2116 created a new tax on hospitals to fund OHP Standard, including an expansion of the number of individuals who can be covered by the program. This was in response to the greater demand for health coverage for low-income adults who do not qualify for traditional Medicaid under the OHP Plus program.
The hospital tax is designated for OHP Standard services and administration only. OHA cannot redirect these funds to another program.
Q. How will Oregonians save with the OHP Standard program expansion?
A. Oregonians who have health coverage are able to get early treatment for illnesses and conditions, which cost the state less. Without access to affordable health coverage, including the preventive services OHP Standard emphasizes, Oregonians are less likely to be healthy. High-quality health care helps prevent illness and chronic diseases by allowing people to obtain treatment before a medical condition reaches a critical, high-cost stage.
A person with OHP Standard coverage will be able to have regular doctor appointments and resolve medical issues quicker than if they did not have coverage. When Oregonians without health coverage go to the emergency room, their medical issue is usually further along costing more to treat.
Other ways Oregonians benefit:
- Oregonians who are healthy are more productive at work and have fewer absences, helping the state economy to thrive.1
- Family stability increases when parents have health coverage.1
- Providing health care coverage reduces the cost shift to anyone paying for services. Unreimbursed health care is estimated to account for 9 percent of the premium cost for commercial health insurance in Oregon.1
- Adults without coverage more often go without recommended screenings for hypertension, cancer, diabetes, and other chronic conditions, delaying diagnosis until the disease is more advanced.2
- Adults who have no coverage for a year or more miss timely eye, foot and blood pressure exams that help prevent blindness, amputation and cardiovascular disease.2
- 41 percent of adults who lost coverage had uncontrolled high blood pressure (compared to 8 percent of adults with continuous coverage).2
- Uninsured adults are 30-50 percent more likely to have avoidable hospitalizations (e.g., treatment for diabetes or pneumonia). In 2002, the average cost of an avoidable hospitalization was estimated to be $3,300.2
1 DHS 2009-2011 Budget presentation to the 75th Legislative Joints Ways and Means Committee and Human Services Subcommittee, February 2009
2 Trends in Oregon's Health Care Market and the Oregon Health Plan. Report to the 75th Legislative Assembly, February 2009.
Q. Why did OHA dramatically cut some services while others received smaller or even no reductions during the current budget shortfall?
A. OHA only had to make reductions in programs funded by state revenues, also known as "general fund." Programs funded through other sources such as the federal government or other funds including grants, either had to make smaller or no reductions depending on the funding source. Also, OHA is not allowed in most cases to move funds from program to program.
For example, Supplemental Nutrition Assistance Program (SNAP) client benefits are 100 percent federally funded. As a result, these benefits are not included in the reduction, OHA is not allowed under law to use those funds for program. Another example is the OHP Standard program, which is funded by a combination of the Oregon provider tax and federal Medicaid match. Cutting benefits or the number of people enrolled in the program would not make a reduction in the state general fund in any way.
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