Oregon is undertaking a number of efforts to transform the Oregon Health Plan (OHP) as we work toward the goal of eliminating health inequities by 2030 using available state and federal pathways. Below are details about some of the major past, present and future initiatives Oregon has explored in the next phase of transforming our health system.
Increasing access to health coverage and ensuring continuity of coverage
Creation of a Basic Health Program
House Bill 4035 requires the Oregon Health Authority (OHA) to create a new “bridge program" to provide an affordable, comprehensive source of health coverage to adults in Oregon with income between 138-200% of the Federal Poverty Level. Implementing this program will prevent coverage loss among some people who would otherwise lose OHP during the unwinding of the federal Public Health Emergency.
Oregon will seek Centers for Medicare & Medicaid Services (CMS) approval under
Section 1331 of the Affordable Care Act that gives states the option to establish a Basic Health Program.
State Plan Amendment for postpartum individuals
Oregon's request to expand Medicaid and Children's Health Insurance Program (CHIP) coverage, known as OHP, to one year postpartum was approved by CMS in May of 2022. The change will allow individuals to maintain continuous OHP coverage and access medically necessary physical, oral and behavioral health services for 12 months after childbirth.
Social Determinants of Health Initiatives
Health-Related Services through coordinated care organizations (CCOs)
Health-related services are non-covered services that are offered as a supplement to covered benefits under Oregon's Medicaid State Plan to improve care delivery and overall member and community health and well-being. Health-related services include:
Flexible services, which are cost-effective services offered to an individual member to supplement covered benefits, and
Community benefit initiatives, which are community-level interventions focused on improving population health and health care quality. These initiatives include members, but are not necessarily limited to members.
CCO-funded Supporting Health for All through Reinvestment: the SHARE Initiative
SHARE Initiative comes from a legislative requirement for CCOs to invest some of their profits back into their communities. After meeting minimum financial standards, CCOs must spend a portion of their net income or reserves on services to address health inequities and the social determinants of health and equity.
State-funded OHP programs for people excluded from federal Medicaid because of their immigration status
Oregon uses state funds to fill gaps in services for individuals who are not eligible for Medicaid federally because of immigration status. Examples include the following:
What is in progress
Creating a State Plan Amendment to cover more providers outside the medical model
Providers outside the medical model include traditional and community health workers, personal health navigators, peer wellness and support specialists, and doulas. These service providers often live and work in the same communities as OHP members, which means they can deeply understand what OHP members experience. By ensuring the state pays them enough for the services they provide, OHP members will receive more culturally responsive care.
House Bill 3353 and Community Investment Collaboratives
House Bill 3353 requires CCOs to:
- Spend more money on programs and services that improve health equity, and
- Be more accountable to the people they serve.
To help solve health inequities, Oregon needs to give power and resources to communities. One way to do this is by funding new Community Investment Collaboratives (CICs). CICs will decide which problems are a priority to address and how funding will be spent to reduce health inequities as part of implementation of House Bill 3353.
CICs will be coalitions led by community groups whose focus is pooling and investing health care dollars in populations and communities that have been most harmed by historic and contemporary injustices and health inequities.
OHP access for individuals leaving state custody
Oregon is continuing to work with CMS to explore the possibility of waiving the federal rule preventing a person in custody from accessing Medicaid benefits
Right now, when OHP members enter state custody (like prison or the Oregon State Hospital) they lose Medicaid coverage. When they're released, it can take up to two weeks to get covered again, which often means weeks without care (doctor appointments, medicine, etc). To help fix this, Oregon wants to:
- Provide coverage to eligible young people, even if they're in the juvenile correction system. For many young people, this will mean staying on OHP.
- Provide OHP coverage or appropriate CCO transition services to OHP members, even when they're in the Oregon State Hospital, psychiatric residential facilities, and prison. For people in prison and the state hospital, coverage would start 90 days before their scheduled release.
- Provide OHP benefits and CCO enrollment for OHP members in county jail or local correctional facilities, including people waiting for their court date.
American Indian and Alaskan Native health care priorities
In an effort to strengthen and improve coverage for the American Indian/Alaska Native beneficiaries, the state also requested authority to remove prior authorization requirements for these beneficiaries, convert the Special Diabetes Program for Indians (SDPI) to a Medicaid benefit, reimburse tribal-based practices, and extend coverage of new health-related social need services to tribal members not enrolled in a CCO. CMS recognizes the importance of addressing health disparities in Oregon’s American Indian and Alaska Native communities, and will continue to explore these proposals with the state.