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Rose's Topic of the Week #2
New help from Washington and Salem for members who lose Medicaid coverage


Oregon Health Plan “churn” – members going on and off OHP coverage because of changes to their income – is a significant barrier to consistent and ongoing health care for our Medicaid members.

Rose Englert, senior manager of regulatory affairs
Rose Englert

Churn is caused by members suddenly earning too much money to be eligible for OHP, or after an expectant mother gives birth. (The baby will be covered, but the mother may not.) When there’s a break in coverage, continuity of care from the Coordinated Care Organization can be lost. That could lead to health problems, because ongoing preventive care is key to maintaining health.

Luckily, some recent developments will help reduce the effects of churn and help OHP members keep their coordinated care.Perhaps the most exciting thing for adult enrollees is that, beginning Jan. 1, 2014, OHP beneficiaries will be enrolled for a continuous 12-month term. Currently, only children are enrolled for a full year at a time; adults must re-enroll every six months, or sooner if their income changes.

It’s a happy surprise that the federal government is allowing this change, which is happening only in Oregon because of a special waiver. CareOregon, however, is working with our congressional delegation to help pass a law that would allow every state to change to a 12-month enrollment period.

This year-long enrollment is very good news, because CareOregon and CCOs statewide will be able to design and implement continuous care plans for members, knowing they will have a guaranteed 12 months of coverage.

And even if members do lose coverage after a year because of an increase in income, they will still have affordable health insurance options. Instead of paying full price for a commercial insurance plan, former members can transition onto a subsidized private plan (like the CO-OP).

Starting in January, Oregonians will be eligible to purchase commercial plans through Cover Oregon, our state health insurance exchange. The exchange is an online shopping tool for individuals and small businesses to purchase insurance. Those plans offer significant subsidies to individuals and families on a sliding scale, based on income and family size. To help eligible Oregonians learn about and sign up for this coverage, the state has received a $2.8 million grant from the federal government to fund health insurance navigators statewide.

Another law passed during the 2013 session requires the Oregon Health Authority and Cover Oregon to present a plan by January 2014 to help members move between OHP and the health insurance exchange as their circumstances change. CareOregon will work with that task force to identify strategies to assist in those transitions, and we are excited about the opportunities Oregonians will have to more easily maintain access to good, affordable coverage.