Oregon will fund children's health coverage through April 2018

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Issues and actions in Oregon health today

Nov. 30, 2017

Oregon to fund CHIP despite Congressional inaction

The Oregon Health Authority will continue health coverage for children and pregnant women who rely on the Children’s Health Insurance Program (CHIP), despite Congress’ failure to reauthorize the program. CHIP provides coverage for vital health services such as prescriptions, doctor’s visits, preventive care and emergency care.

OHA took action in response to a letter from Governor Kate Brown directing the agency to keep children’s health coverage in place through April 2018.

Congress failed to renew funding for the program in September, but Oregon secured $51 million in one-time left over CHIP funds to last through December. After that the state runs out of money to cover children on CHIP.

CHIP covers children from low- and middle-income families whose parents make too much to qualify for Medicaid but who may struggle to afford to buy coverage in the marketplace. Currently 120,000 Oregon children and 1,700 pregnant women rely on the federally funded program.

Watch this video featuring a family that was helped by the CHIP program.

CHIP video capture

OHA responds to Medicaid audit

Yesterday the Secretary of State released an audit of payments in Oregon’s Medicaid program. The audit recognized several existing, effective processes within OHA and made several recommendations to improve how OHA processes Medicaid payments.

OHA Director Patrick Allen said, “We will implement each of the audit team’s recommendations and report our progress to the Governor and the public.”

OHA leaders did not agree with all the audit’s estimates or assumptions. For example, the audit identified $88 million in “avoidable” payments for about 115,000 children and adults on the Oregon Health Plan. Federal officials approved suspending eligibility renewals for these cases after Cover Oregon failed. Federal law obligates Oregon to pay for health coverage for vulnerable children and adults until each person completes the renewal process.

In addition, the audit identified 31,000 “questionable” Medicaid payments. However, a sample check of 2,700 of these transactions found that more than 98 percent were appropriately made.

Director Allen said, “I do appreciate the SOS audit team’s recognition that Medicaid is a massive and complex program to operate.” To put the findings in context:

  • The fee-for-service payment error rate in OHA’s Medicaid program is below the national average.
  • The $88 million in audit-identified “avoidable” state and federal expenses accounts for less than 1 percent of Oregon’s annual $9.3 billion Medicaid budget.
  • The 31,000 “questionable” payments account for only 0.06% of the more than 52 million payments OHA processed during that period.

Director Allen also said, "While OHA has successfully expanded health coverage to more than 400,000 Oregonians and saved taxpayers $1.3 billion in health care costs, the effort to meet these challenges (as well as respond to the Cover Oregon failure) has not allowed us to build a foundation of consistent operational rigor and accountability in our Medicaid operations.

"We can do better. We are making changes to improve the accuracy and transparency of our programs.”


OHA extending contract with coordinated care organizations

OHA is extending its current five-year contract with the coordinated care organizations (CCOs) for another year. The contract was set to expire December 31, 2018. It will now be extended to December 31, 2019.

This decision was reached in collaboration with OHA's health care transformation partners including the Legislature, Governor Brown’s office and the Oregon Health Policy Board.

This extra year will give OHA time to develop a new five-year contract that will further advance Oregon’s health transformation goals.

The agency is drafting a governance structure and forming teams to accomplish this work, and hopes to have them in place by the end of December.

OHA is proud of the work CCOs have done to transform the health care delivery system to bring better health, better care and lower costs to Oregonians and hopes to continue this work with the next contract.   .

You can learn more about the history of CCOs and how coordinated care organizations work on the OHA website.