MM Curator summary
Oregon is getting ready to begin the disenrollment process for those no longer eligible once the pandemic is declared over, but is hoping to make the application process easier moving forward.
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More Oregonians than ever before are using the state’s free health care during the pandemic — but for many, that could change in a few months.
A set of changes to federal law are expiring next year, potentially causing thousands to lose their access to the Oregon Health Plan, the state’s Medicaid program, which provides health and dental benefits to low-income Oregonians.
“Enrollment in (Central Oregon) has grown since the pandemic started. That’s pretty consistent with what’s happening across the state,” said Lindsey Hopper, a vice president with PacificSource who oversaw Medicaid in Central Oregon for much of the pandemic.
In June, there were about 13,000 more people in Deschutes, Jefferson and Crook counties covered by the state’s Medicaid program than there were at the start of the pandemic last March, according to an analysis of Oregon Health Authority data.
As economic turmoil forced hundreds of thousands of layoffs statewide, more people lost their employers’ coverage and couldn’t afford their own, causing a spike in applications last spring.
But most of the increased enrollment comes from a mundane change to the annual renewal process: In the first pandemic relief package from March 2020, Congress asked states to keep Medicaid members on the rolls during the pandemic, even if their incomes rose or they missed their renewal paperwork.
“We think all of those things contribute to what happens to enrollment in the Oregon Health Plan,” Hopper said.
Oregon’s Medicaid enrollment is expected to keep growing to more than 1.4 million next summer, up from around 1.1 million prior to the pandemic.
Despite Central Oregon seeing more than a 20% increase in health plan members compared to before the pandemic, it’s actually been easier for some agencies to help people get covered during the pandemic.
“So our traffic is down, but every person we get stays on (the plan) until the end of the pandemic,” said Sean McAnulty, who supervises a small team of insurance enrollment assisters with Mosaic Medical.
McAnulty’s team helps Central Oregon residents figure out what low- or no-cost health insurance options are available to them.
Now, the continuous enrollment rules have reduced their caseload by about half.
The rules for showing proof of income were also relaxed, and the ability to work through applications over the phone has allowed Mosaic’s team to spend more time helping clients actually use their coverage once they’re enrolled.
“We’re providing a higher level of assistance as we have more time for each case,” McAnulty said. “There’s a lot of navigation after. Getting someone benefits doesn’t mean they end up using them.”
That means doing things like helping members set up their first appointments once they’re covered.
Changes on horizon
Once the pandemic ends — or, at least, the federal government’s public health emergency declaration expires — the pandemic eligibility rules go away.
That means the state will again begin reevaluating the eligibility of those on the plan, and anyone whose income has risen above the Medicaid threshold since they got on the plan or who hasn’t kept up with their paperwork will receive a notice that their coverage could expire.
“Whenever there’s going to be something like this, there’s always going to be people who fall off,” McAnulty said. “This is why we’re here, is to help people navigate that.”
Since the change is dependent on the federal declaration, precise timelines aren’t yet set in stone. Projections from the Oregon Health Authority suggest the declaration will likely expire in January 2022, and re-enrollment eligibility will be determined over the next six months .
An estimated 200,000 members statewide will lose their coverage when rules change. Some of those people will be losing coverage because they’re no longer eligible, such as if they returned to their jobs and now make more than the income requirement.
But many will be part of what Lori Coyner, Oregon’s former Medicaid director, calls the “churn population,” those who frequently are off-and-on with the state’s insurance policy as their incomes fluctuate or they miss their paperwork.
That churn, all but eliminated by the pandemic’s enrollment rules, makes it harder for people to access the health care they might be eligible for.
“We do know that when people stay on, they keep their doctors, they keep their providers, where to get their prescriptions filled and all of that,” Coyner said. “When they drop off and then come back on, they have to re-establish all of that.”
Pandemic’s impact could be here to stay
Coyner’s goal now is to avoid some of those on-and-off relationships by making some of the pandemic’s lessons permanent fixtures of the Oregon Health Plan.
It’s a perfect time: The state’s renegotiating its five-year agreement with the federal government laying out exactly how Medicaid in the state will operate outside of typical federal rules.
Coyner, now a policy advisor heavily involved in designing the agreement, said the state hopes to make permanent the pandemic provisions reducing how often people have to reapply and reducing the amount of financial paperwork they have to submit.
“We learned that it’s much faster for people to apply and get their application in, and then we can do the income verification later instead of having to have them get a check stub right at the front end,” Coyner said.
Those changes to the plan still have to be approved by the federal agency that oversees Medicaid, and wouldn’t be finalized until the new agreement takes effect next summer.
Aside from all the technical hoops temporary rules may have eliminated, the pandemic “shined a light” on disparities in access to care, added Dana Hittle, now the state’s interim Medicaid director.
“For all of the flexibilities, or a good number of the flexibilities, that we were able to put into place because of the pandemic that we want to continue,” Hittle said, “the goal is to make it as easy as possible for people to have access to health care and remove those barriers.”