Issues and actions in Oregon health today

June 16, 2017

In this issue ...

• Oregon House votes to protect health coverage for more than 350,000 Oregonians
• Gains in OHP application processing and call wait times
• Update on Medicaid eligibility clean-up
• Oregon moves to centralize benefit eligibility processing

Oregon House votes to protect health coverage for more than 350,000 Oregonians

The Oregon Health Authority cleared a big hurdle Thursday when the agency’s budget bill (HB 5026) passed the House of Representatives. Part of OHA’s budget package includes a comprehensive provider assessment created in HB 2391 that will help fund the Oregon Health Plan for the upcoming biennium as federal support for the Medicaid expansion population decreases.

The package now moves to the Senate for final approval.

The provider assessment and the main budget bill include:

• More than $650 million in revenue to help fund the Oregon Health Plan for the upcoming biennium as federal support for the Medicaid expansion population decreases. This will ensure the continued coverage of 350,000 Oregonians who joined OHP as part of the Affordable Care Act's Medicaid expansion.
• $5 million to help fund Public Health Modernization, which ensures basic public health protections critical to the health of all Oregonians.
• Funding to maintain operation of the Junction City campus of Oregon State Hospital at current capacity.
  

Gains in OHP application processing and call wait times

The new June Member Services Dashboard out this week shows our current numbers in processing Oregon Health Plan (OHP) applications and reducing call wait times:

• Responding to member calls: Nearly 60 percent of calls were answered in 10 minutes or less.
• Fewer calls experience long holds: Maximum call wait times have increased since April due to the beginning of the annual renewal cycle, but are still down 16 percent from January.
• Application backlog: The application backlog – the number of applications older than 45 days that are awaiting an eligibility determination - was completed in May.

OHP enrollment is now slightly more than 1 million members. We’ll continue to track our progress and post our results each month.

Update on Medicaid eligibility clean-up

Last week OHA shared an update on plans to complete the last stages of Medicaid eligibility clean-up with the Governor and legislators. The data clean-up plan was approved by the federal Centers for Medicare & Medicaid Services (CMS) in 2015.

As of May 1, 2017, more than 733,600 Oregon Health Plan (OHP) members have been found eligible to continue receiving OHP coverage. We are finalizing the eligibility renewal process for a remaining 115,236 cases. These remaining cases have been housed in older databases. They were triaged for the final stage of the Medicaid clean-up due to their complexity. Here are some of the programming challenges this week’s analysis identified:

• OHP members who are still in a legacy system and did not renew eligibility into the ONE System, but live with an individual who has already renewed his or her eligibility into the ONE System.
• OHP members who successfully renewed via the ONE System, but an update was made to their old legacy system file, causing benefits to appear in the old system.
• Members who started the renewal process in the ONE System but are still missing information.
• Members who submitted renewal applications both on paper and electronically, and require a manual reconciliation of the two applications.
• Members who meet multiple eligibility criteria in a household with other members who meet only a single criteria or different criteria.

The clean-up process will be completed by August 31, 2017.

At that time all Medicaid case renewals will be in the ONE system and on an up-to-date renewal cycle. You can review Director Saxton’s presentation on this topic to the Senate Health Care Committee here.

Oregon moves to centralize benefit eligibility processing

This week OHA Director Lynne Saxton and Department of Human Services (DHS) Director Clyde Saiki shared the following announcement with OHA and DHS employees and community partners:

Earlier this year we announced our agencies were convening a project team to explore the centralization of financially based benefit eligibility decision-making between our agencies – i.e., integrating TANF, SNAP, Medicaid and other benefits for effectiveness and efficiency. We want to provide you an update on the Integrated Eligibility/Medicaid Eligibility (IE/ME) project.

Our agencies share a commitment to provide Oregon families access to the services and supports they need to lead healthy and productive lives. More than 60 percent of the people to whom OHA provides Medicaid services also receive benefits or services from DHS. The goal of integrated eligibility is to centralize and streamline the benefit eligibility process to make it more efficient and easier to navigate for our clients.

As part of this vision, we intend to centralize the Medicaid eligibility determination process:

• Integrating the benefit eligibility process for Medicaid with other financially based eligibility benefit programs managed by DHS.
• Fulfilling the original OHA-DHS vision for the ONE eligibility system and providing our shared customers one doorway through which to access services (rather than having to engage multiple agencies).
• Maintaining OHA’s role as the state Medicaid agency leading health transformation in Oregon and serving as the single state Medicaid agency responsible for working with the federal Centers for Medicare & Medicaid Services (CMS).

The first steps in this long-term vision is centralizing Medicaid eligibility at DHS later this year. While this transition is underway, OHA will continue to administer the Medicaid eligibility process.

The IE/ME project team is still early in the planning and implementation process and we are working partners. This transition will require changes in organizational structure, reporting and staffing – e.g., OHA’s Member Services team will move to DHS in coming months as part of this transition.

Both agencies are working closely together to carry out a collaborative transition process that minimizes disruption for clients and staff and provides adequate and appropriate training, technology and support.

Our shared goal of providing effective and efficient health and social services is at the heart of this transition. We appreciate your partnership in improving the lives of Oregonians.