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The Oregon Health Authority (OHA) is pleased to announce that it has submitted a final 1115 Medicaid demonstration waiver renewal application to the Centers for Medicare & Medicaid Services (CMS). Oregon’s application will continue foundational elements of the Oregon Health Plan with a substantial focus on addressing health inequities in our state, while maintaining our commitment to achieving universal coverage and delivery system reforms that promote high-quality care while containing costs.
OHA based the application’s policy proposals on extensive feedback from OHP members, advocates, health care partners and other interested parties as well as the nine federally recognized Tribes. Given the interest shown and the significance of this application, we felt it important to share some of the highlights of the final application along with a summary of what changed as a result of our public comment period.
As you will see in the summary and the application, Oregon chose to focus on core policy proposals. These include:
Maximize continuous and equitable access to coverage
The renewal’s approach includes two-year continuous enrollment for adults, five-year continuous enrollment for children until age 6; and expanded coverage for people in Oregon experiencing periods of transition.
Improve health outcomes by streamlining life and coverage transitions
By providing specific benefit packages that focus on meeting the social needs of members in transition between settings and stages of life, Oregon can better ensure people stay covered, have important social determinants of health needs met and maintain access to care and medicine, which ultimately improves health outcomes.
Move to a value-based population payment
To maintain and build on our successes, Oregon must continue to build a payment system that rewards spending on health equity, social determinants of health and improving the overall health of Medicaid and CHIP beneficiaries, rather than spending on medical procedures and services alone.
Incentivize equitable care
OHA proposes revising performance metrics to focus not only on traditional quality and access for downstream health while also creating a new set of equity-driven performance metrics for upstream health factors, Oregon can make significant progress in driving the system toward more equitable health outcomes.
Improve health through focused equity investments led by communities
The state is requesting to make equity-focused investments that redistribute resources and decision-making power to the community itself. These policies would support community-driven investments in health equity and the development of essential financial and data infrastructure for community-based organizations providing these services.
Alignment with Tribal partners’ priorities
Oregon is committed to working with the nine federally recognized Tribes in Oregon and the Urban Indian Health Program (UIHP) to identify mechanisms to achieve Tribal health care objectives while honoring traditional Tribal practices and upholding the government-to- government relationship between the sovereign nations and the state.
Public comment
OHA conducted an extensive public comment period from Dec. 7, 2021, until Jan. 7, 2022, during which time all interested parties were invited to give feedback on the draft application. Additionally, OHA conducted Tribal Consultation and Urban Indian Health Program Confer on Dec. 14, 2021. All feedback collected during the public comment period is available in the application document starting on page 144. A summary of public comments is available on page 246.
Next steps
OHA will now enter negotiations with CMS over the application’s proposals. Final decisions are expected by the autumn of 2022, though the timeline could shift.
OHA was gratified at the interest and feedback interested parties across Oregon have shown throughout the process and looks forward to continuing to shape the future of OHP in a collaborative and transparent manner.
If you have questions or comments, please email 1115Waiver.Renewal@dhsoha.state.or.us.
For more information, please visit Oregon.gov/1115WaiverRenewal.
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