Oregon health care coverage for children from low-income households and young adults guaranteed under a federal agreement

Under a new agreement, the federal government will give Oregon $1.1 billion to ensure continued free health care coverage for tens of thousands of young children in low-income households and provide broader coverage to low-income young adults, especially those with special needs.

The agreement, announced Wednesday in a conference call with Centers for Medicare & Medicaid Services officials and Oregon Governor Kate Brown, also includes expanding Medicaid coverage to include housing and medical care. food aid.

Social services assistance means that Medicaid in Oregon will pay recipients for rent, utilities, and other housing needs for up to six months; provide assistance with housing applications, moves and eviction prevention and assign a case manager to coordinate services. Oregon’s health plan, the state’s version of Medicaid, will also provide cooking and nutrition classes, food boxes, medically appropriate prepared meals and help getting federal food benefits.

Additionally, Medicaid in Oregon will pay for air conditioners before a heat wave, air filters when wildfire smoke clogs the air, and generators during extreme cold spells. Medicaid providers in Oregon have already done so, but the agreement means coverage will be expanded, officials said.

Chiquita Brooks-LaSure, administrator of the federal Centers for Medicare & Medicaid Services, and Brown called the agreement groundbreaking.

“Keeping young children permanently enrolled in Medicaid until age 6 to avoid coverage gaps regardless of changes in their financial circumstances is a paradigm shift,” Brown said on the call. “We’re going to be the first state in the country to do that.”

The Oregon Health Authority said it plans to include 9,050 additional children under age 6 in Oregon’s health plan by July 1, 2023. By July 1, 2026, it will expects an additional 51,400 children to be covered. Currently, 508,000 Oregonians under the age of 21 are covered by Medicaid, said Liz Gharst, spokeswoman for the Oregon Health Authority.

Oregon’s health plan provides free physical, mental, and dental coverage for adults earning about $1,550 a month or about $3,100 for a family of four. Children in a single-parent household earning nearly $3,500 or those in a four-person household earning nearly $6,700 a month are eligible for state and federal coverage.

About two-thirds of Medicaid is paid for by the federal government and the rest is paid for by the state.

Under the agreement, the federal government will pay Oregon $1.1 billion to expand benefits. The state estimates the new coverage will cost Oregon nearly $500,000 in general fund money through June 30, 2027.

Statewide, 1.4 million people, or more than one in three Oregonians, are covered by the health plan. Since the pandemic hit, Oregon has added about 400,000 people to Medicaid rosters. Brown said the pandemic has made disparities in health coverage apparent and has had a disproportionate impact on people of color, low-income people and rural residents.

“(The state) has learned critical lessons from the pandemic: such as the benefits of maintaining continuous enrollment to avoid gaps in coverage, increasing access to care, reducing the number of uninsured and under -assured and promote better health outcomes overall,” Brown said. .

Some of these lessons are incorporated into the agreement. In addition to guaranteed coverage for children, the agreement will ensure that people age 6 and older are enrolled in Oregon’s health plan for two years, even after a change in eligibility status.

The “churned” population

The state has long cared for a so-called “churn population” who use and turn off Medicaid, based on their income. During the pandemic, states received extra money from the federal government to provide coverage for people even if their financial circumstances changed, but that provision will end when the Biden administration declares an end to the public health emergency. The government has renewed it every three months since January 2020. It is now due to expire in mid-October.

Keeping people covered reduces administrative work, ensures better care and lowers overall costs, Brown said. People who don’t have health insurance often go to the emergency room for treatment. Emergency care is among the most expensive, and reliance on the emergency room means patients often don’t receive treatment until their condition worsens. Preventive care, a feature of Oregon’s Medicaid system, helps keep people healthier and catches problems before they become acute.

The agreement, as part of the state’s waiver of traditional Medicaid requirements, aims to provide housing and food assistance to low-income people with special needs, defined as those between the ages of 19 and 26 who suffer a serious chronic illness, an emotional problem or a diagnosed disability. . The expanded coverage is also aimed at young people leaving foster care, at risk of entering foster care or those leaving foster care. Most people in foster care are single at 18.

The state estimates that 140,000 people will be eligible for housing, food and other social benefits when these are added in 2024.

Social services assistance will also be extended to people upon release from state or tribal custody, people who are homeless or at risk of becoming homeless, and low-income and eligible seniors 65 and older. to health insurance because of their age, the health insurance system for the elderly.

The agreement also provides for periodic physical, mental and dental screenings of under-21s.

The coverage expansion is part of Brown’s effort to eliminate health inequities by 2030. Almost all children have health insurance in Oregon, and nearly 95% of adults are covered.

“Clearly we need to look beyond a traditional, siled approach to truly meet the needs of people, especially those facing complex challenges,” Brown said. “Everyone – regardless of race, age, income level, gender, zip code, or lack thereof – deserves access to affordable, quality health care.”

The health authority said Oregon’s health plan will continue to provide coverage based on a priority list of services approved on the basis of scientific evidence. The waiver also guarantees that the state will cover all medically necessary and appropriate care required for the treatment of children up to age 21 beginning January 1. By law, Medicaid is supposed to cover all medically necessary treatment, but earlier this year, The Lund Report revealed that the plan suddenly turned down hormone treatment that a boy received for years as a teenager. The treatment costs $20,000 a year.

Deck plan

A state task force established by the Legislative Assembly in 2019 to design a universal health care coverage plan recently released its proposal that would provide generous medical, mental and dental care.

Patients wouldn’t pay for office visits or any other copayments or coinsurance, and they wouldn’t have deductibles, which must be met for coverage to begin. They also wouldn’t have to buy health insurance, and the state would remove employer-based coverage.

The plan would be funded by more than $20 billion in new income taxes on employers and individuals. The task force, made up of state officials, medical experts and insurance company executives, recommended that the state oversee the program and include seniors on Medicare as part of the federal law. Consumers would pay for services not covered by the plan.

Proponents say the plan would cost Oregon less overall because of savings on health insurance and out-of-pocket care costs. But critics lined up against the proposal, saying the state overstated the financial benefits and the plan would cost Oregon more.

Some other states have pushed for universal coverage, but none have adopted it. Massachusetts is the closest. State Governor Charlie Baker was also on the conference call, announcing the passage of a hospital initiative that is expected to improve the quality of care and reduce health disparities under his own Medicaid waiver.

Although the universal health care proposal is far from being adopted in Oregon, the state is on its own expanding coverage beyond Medicaid. Last February, the legislature approved an Oregon Health Authority plan to create a new insurance plan for low-income people who earn too much to qualify for Medicaid. The “bridge plan” would apply to people earning around $2,800 a month or nearly $5,800 for a family of four. It will go into effect when the federal health emergency ends and people are kicked out of Medicaid for earning too much.

The state estimates that about 300,000 would qualify for the bridge plan.

This coverage and the Medicaid waiver will bring Oregon closer to its statewide coverage goal.

“We’re on the path to making sure everyone in Oregon has access to the health care they need, when they need it,” Brown said.

By Lynne Terry of Press Partner Oregon Capital Chronicle

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