Oregon's Medicaid Demonstration
Waiver application submitted to Centers for Medicare and Medicaid Services
Oregon's Medicaid Demonstration renewal request has been submitted to the Centers for Medicare and Medicaid Services (CMS) for review and approval. If approved, the waiver would run from July 1, 2017 through June 30, 2011. The state anticipates working with CMS over the coming weeks and months to refine the application for approval. Approval must be received from CMS before Oregon can implement the new waiver.
The submitted application, including all appendices and public comment logs, can be found here.
In submitting the 2017 renewal request, Oregon has committed to continuing and expanding all of the elements of the 2012 waiver, particularly around integration of behavioral, physical and oral health integration, and has included a significant focus on social determinants of health, population health, and health care quality.
The renewal reflects Oregon's vision to build on the foundation of Oregon's health system transformation, including:
- An expanded focus on the 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
- A strong focus on social determinants of health and health equity across all low-income, vulnerable Oregonians with the goal of improving population health outcomes
- A commitment to an ongoing sustainable rate of growth that includes the 2 percent test, putting the federal investment at risk for not meeting that target and adopting a payment methodology and contracting protocol for CCOs that promotes increased investments on health-related services and advances the use of value-based payments
- Continuing to expand the coordinated care model, including innovative strategies for ensuring better outcomes for members eligible for both Medicare and Medicaid
How input was collected
- Written comments through June 1, 2016 – Newsletters, emails, and public meeting notices were sent to Tribes and stakeholders, and notices were published on the OHA and Secretary of State’s websites soliciting written comments.
- Via an online survey
- At numerous face-to-face meetings and public hearings with stakeholders, Tribal government leaders and the public.
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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.
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. This waiver was for a five-year period, running from July 2012 through June 2017. Oregon and CMS hope to continue this work with a further waiver renewal and amendment for another five-year period from July 1, 2017 through June 30, 2022.
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 and CMS 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). 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.