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2022-2027 Medicaid 1115 Demonstration Waiver

Overview

In the next few years, Oregon will be making a number of changes to Oregon Health Plan (OHP) as a part of the next phase of transforming our health system. When more Oregonians have health coverage and supporting social services, people and families are healthier, our communities thrive and health care costs are contained for everyone. Some of these changes will be happening through the 2022-2027 Medicaid 1115 Demonstration waiver.

What is a Medicaid Waiver?

Medicaid is a state and federal program. A state must apply for a Medicaid waiver when it wants to make changes from normal federal guidelines. OHP, Oregon's Medicaid program, delivers health care to people who have low incomes. A state can ask to waive certain regulations for greater flexibility around the following and more:

  • Who is eligible for Medicaid 
  • What benefits they receive  
  • How health care is delivered to Medicaid members 

Feb. 18, 2022, Oregon submitted a 2022-2027 waiver renewal application (known as the 1115 Demonstration) to the Centers for Medicare & Medicaid Services (CMS). The purpose of the waiver is to transform our state's Medicaid program to better serve our members.  

A federal waiver creates an opportunity for OHP to: 

  • Build on our state's health care transformation success, and 
  • Create a more equitable system.

Final Approved Waiver

Sept. 28, 2022, CMS provided Oregon final decisions on allowed changes to OHP during the 2022-2027 demonstration period. View the approved waiver.

About the 2022-2027 Waiver

Oregon’s 2022-2027 1115 waiver continues the foundational elements of OHP in addressing health inequities in our state. These inequities result in adverse health outcomes for affected groups. These include people of color and Tribal communities, people with low income, people with disabilities, people who identify as LGBTQIA2S+, among others.

People in communities of color and Tribal communities are nearly twice as likely to be uninsured. African American, Pacific Islander, American Indian/ Alaska Native, and Latina women have lower rates of first trimester prenatal care than White women. People living in poverty experience higher rates of homelessness and food insecurity.

To make progress on these inequities, we need to ease the challenges individuals and families face. We believe that focusing on eliminating health inequities, as well as clearly aligning with other health policy initiatives in our state, will allow us to:

  • Make significant improvements for individuals who face historic and contemporary injustices;
  • Increase individual, family and community resilience; and
  • Reduce health disparities for groups disproportionately affected.
Oregon's 2022-2027 waiver will seek to build on Oregon's history of innovation in health care, and make progress towards our main goals:

Creating a more equitable, culturally- and linguistically-responsive health care system

Overall, the intention of the 2022-2027 waiver is to advance OHA's goal of eliminating health inequities by 2030. The application explored different ways to affect health outcomes for communities and groups that have been disproportionately affected by health inequities in our state.

 This includes groups that have been economically and socially marginalized, such as individuals who are experiencing homelessness, people in need of food supports, people most impacted by climate events, and disadvantaged youth.

Ensuring people can maintain their health coverage

About six percent of people in Oregon don't have health insurance. Of this six percent, many are OHP members who lose health insurance coverage because of a temporary change to their eligibility, like making more money one month. When people lose coverage — even for short periods of time — they miss health care appointments and lose contact with their providers, which means they don't get care when they need it. Delaying care can cause people to get sicker, need more care overall, and have more health care costs in the end.

Oregon has been a national leader in helping people get and maintain coverage using federal and state pathways.

Improving health outcomes by addressing social needs that impact health

There is a growing understanding that social issues can have a big impact on a person's health. Where people are born, live, learn, work, play, and age can affect health outcomes and quality of life.

Having access to healthy foods and affordable and safe housing can make a big difference in a person's ability to be and stay healthy. Oregon is creating several ways to work more “upstream" (see graphic below) to address social issues that affect our health and support those already working in our communities on these issues.

Describes the differences among upstream, midstream and downstream strategies

Ensuring smart, flexible spending for health equity

Oregon is using new and innovative federal funding pathways to fund health equity programs. Designated State Health Programs (DHSP) allows for states to ask for federal funding. This pathway will allow Oregon to fund parts of the waiver, such as covering social needs for groups disproportionately affected by inequities, with federal funding.

Learn More about What's Changing

Learn details about what’s changing under the waiver.

2022–2027 Waiver Process Development

If you are interested in knowing more about how Oregon developed this waiver, read more about the process.

Other Related Efforts in Transforming our Health System

Learn more about Oregon’s broader efforts to transform the Oregon Health Plan.


Questions?

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Learn about the Future of OHP

Previous meetings:

Documents

Policy Summary

Two-Page Summary: