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Recommendations

Past Medicaid Advisory Committee Policy Recommendations

​Improving access to oral health is critical to meeting the Triple Aim of 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 partners. The MAC and the Oral Health Work Group prepared and submitted recomm​end​ations to OHA to adopt:

  • A standard definition of access,
  • A framework model, and
  • A set of monitoring measures to assess access.

The committee further recommended that OHA develop and share a comprehensive implementation strategy. The strategy would include a communications plan and a ​strategy to review and update the framework and plan over time.​

​A continuous eligibility model serves the aims of the Affordable Care Act by:

  • Ensuring consistent, comprehensive coverage for low-income individuals and
  • Reducing the transition between insurance affordability programs. 
Oregon already had continuous 12-month eligibility for children. In 2015, CMS endorsed continuous eligibility for income-eligible Medicaid adults using section 1115 waivers. 

The committee explored key policy considerations.  The committee prepared and submitted a report to OHA​ that:
  • Assessed the feasibility of this federal policy option, 
  • Outlined the potential fiscal impact on the 2017-2019 budget and
  • Recommends that OHA request this policy as part of Oregon's 1115 waiver renewal with CMS in 2017.  
If OHA adopts the policy, the committee also recommends that OHA:
  • Adopt transparent OHP eligibility, enrollment and redetermination performance indicators,
  • Complete annual assessments of administrative costs that result from churn, and 
  • Complete annual assessments of potential savings to the Medicaid program, CCOs and health providers.

Senate Bill 1526 (2014)​ charged OHA with examining the feasibility of using Children’s Health Insurance Program (CHIP) federal matching funds to subsidize commercial insurance for children. This subsidy, commonly referred to as premium assistance, would apply to families with incomes between 200 and 300 percent of the federal poverty level (FPL). 

OHA asked the MAC to examine this issue and review:

  • The structure of Oregon’s existing CHIP program, 
  • Federal and state regulations related to CHIP and premium assistance, and 
  • Potential impact to individual CHIP members and their families. The MAC reviewed the impact to access and continuity of care, benefits, affordability and whole family coverage. 

Based on this work, the committee concluded that a premium assistance program for Oregon’s CHIP population was not feasible. The committee advised OHA to 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​.​

​The Affordable Care Act increased the number of insured Oregonians through two primary strategies:

  • Expanding Medicaid and
  • Providing insurance through state-based insurance exchanges. 

When an individual's household income exceeds Medicaid income limits, they are eligible for subsidies to buy coverage through an exchange. This applies to households with income up to 400 percent of the federal poverty level (FPL). 

This also works in reverse. If an individual has coverage through the exchange, they will become eligible for Medicaid if their household income falls below 138% FPL. This can cause "churning" where individuals cycle in and out of both programs as their income fluctuates.

To address this issue, the committee submitted a comprehensive report and set of recommendations to reduce, avoid or mitigate future churn between these two programs.​​​

​The committee developed and submitted a set of strategies and act​ions​ to the Oregon Health Policy Board. The recommendations seek to improve person-and family-centered care for Oregon Health Plan (OHP) members.  

The work went across the continuum of care. Each strategy has a set of actions to:

  • Support more person-and family-centered models of care,
  • Contribute to a high-value health care system and
  • Advance the Triple Aim for current and future OHP members.  ​

​Beginning January 2014, the Affordable Care Act:

  • Established new requirements for benefits covering Medicaid expansion populations.
  • Required states to offer a comprehensive package of items and services known as “essential health benefits” (EHB).

From August through November 2012, the committee worked to develop a benefit package that would:

  • Meet all 10 federally required essential health benefits and
  • Meet the benchmark selection criteria.

The committee recommended using the OHP Plus benefit package for non-pregnant adults as the basis for the state’s Medicaid benchmark plan. This would:

  • Simplify, align and streamline benefit coverage across the Oregon Health Plan.
  • Minimize disruption for individuals who move among different OHP benefit packages.

On Jan. 8, 2013, the Oregon Health Policy Board moved to approve the committee's final re​​​​commendation. 

​Studies show that a significant portion of behavioral health treatment occurs in primary care settings. This may be due to the fact that people with serious mental illness frequently also have physical health care problems​. 

The committee chose to examine the topic of behavioral health integration to explore solutions to eradicate health disparities experienced by this population​ and developed recommendations in these areas​:

  • Systems integration
  • Payment reform
  • Services and supports​​

At the request of several partners, the committee:

  • Reviewed key issues surrounding oral health services and the Oregon Health Plan.
  • Developed a set of comprehensive recommendations and report.
  • Submitted the report to the Oregon Department of Human Services.

The robust set of policy recommend​ations, strategies and action steps​ were designed to ensure all Oregonians have access to comprehensive and affordable oral health care.​

​At the request of Governor Kulongoski, the committee reviewed key issues in the design of the Healthy Kids program to cover all Oregon children up to age 19. The committee developed a set of comprehensive recommendations and report​ for the Governor.

House Bill 2116 (2009) ​authorized implementation of the Healthy Kids program.​