2022-2027 Medicaid 1115 Demonstration Waiver

Overview

Medicaid is a national program that provides free or low-cost health care to people of all ages with limited income and resources. It helps people and families who need help paying for medical or long-term care. Across the United States, Medicaid covers 92 million people.

Each state has its own Medicaid program and program names are different from state to state. For example, Washington’s program is Apple Health, while California’s plan is called Medi-Cal. Oregon’s program is the Oregon Health Plan (OHP). OHP covers 1.48 million (or one in three) Oregonians.

What is a Medicaid Waiver?

Every state must follow a standard set of rules determined by the federal government on how to operate. States can, however, ask the federal government for permission to set aside their Medicaid rules. To obtain approval, states must apply for what’s called a waiver. Waivers can allow state Medicaid programs to cover more people, cover more benefits, or deliver care in a different way.

Click here for the history of Oregon’s Medicaid waivers.

Why Is the 2022-2027 Waiver Important?

The current OHP waiver makes Oregon the first state to keep children on OHP covered from birth to age six. Starting January 1, 2023, this means families do not need to renew OHP benefits to keep children covered and can get the health care their child needs in their most formative years.

The 2022-2027 waiver also allows Oregon to:

Keep OHP members ages six and up covered for two years before they need to renew (instead of one).
Cover more preventive health services for people from birth to age 21.
Cover health-related social needs, starting in 2024 for eligible OHP members. This includes support for food, housing, and climate-related resources.

Health-related Social Needs and Health Equity

Where we are born, live, learn, work, play, and age can affect our health and quality of life. Access to health care, healthy foods, and safe housing is important to our health. By supporting these social needs through OHP coverage, the 2022-2027 waiver helps Oregon:

Better coordinate services for people when they most need stability.
Dismantle policies that discriminate against people of color, Tribal communities, people with low income, people with disabilities, people who identify as LGBTQIA2S+ and other groups.
Align with other health policy initiatives in our state to achieve health equity.

Achieving health equity will help Oregon to:

Improve the lives of individuals who face historic and contemporary injustices;
Increase individual, family and community resilience; and
Reduce health disparities for groups most affected by injustice and discrimination.

Who will qualify for services that address health-related social needs?

Determinations about eligibility requirements are currently in process. In 2024, OHA plans to first cover these benefits for OHP members in life transitions. This includes:

Youth ages 19 to 26 with special health care needs.
Youth involved with child welfare, including youth leaving foster care at age 18.
People experiencing homelessness or at risk of homelessness.
People who are transitioning from Medicaid-only to both Medicaid and Medicare coverage.
People released from settings such as jail, residential facilities, and Oregon State Hospital.
People who experience weather-related emergencies. The Governor or federal government declares weather emergencies.