For the first time in three years, the Oregon Health Authority is poised to examine its Medicaid rolls to determine who still qualifies for the free, taxpayer-funded health insurance program.
When the pandemic hit, the federal government extended benefits to states that kept people on Medicaid, and in Oregon, those numbers have swelled by hundreds of thousands of people to nearly 1.5 million, or one in three Oregonians.
To qualify for the program, residents can earn up to 138% of the federal poverty level. That means a single person can make a gross salary up to $18,075 a year, or a maximum of $36,908 a year for a family of four. The Oregon Health Authority, which manages the Oregon Health Plan, expects that 300,000 people who earn more than the ceiling will no longer qualify. But up to 65,000 of them are likely to retain insurance.
The Oregon Health Authority is pursuing a waiver with the federal Centers for Medicare and Medicaid Services to raise the income ceiling to 200% of the federal poverty level during the redetermination process. If the agency approves, a single person earning $29,160 a year or a family of four earning $60,000 annually will still qualify for Oregon Health Plan benefits. The new eligibility is expected to start April 1, the same day that redeterminations will start.
“Health care is vital to Oregon families, and we want to maintain the coverage they depend on,” James Schroeder, the interim health authority director said in a statement. “Our goal is to make sure that everyone who is eligible for benefits, stays covered.”
The state is also pursuing a permanent option to expand health insurance coverage in Oregon. It is developing a Basic Health Program that will offer benefits similar to Medicaid – which covers health care, mental health care, dental care and vision services – for people who earn between 138% and 200% of the federal poverty level. That program is expected Jan 1, 2025.
Lis Gharst, a spokeswoman for the health authority, said the agency expects the new plan will cover 102,000 people, including 12,000 who currently are not insured.
The health authority advised Medicaid members to keep their information up to date to speed the renewal process.
“We expect the majority of medical cases to go through an automated renewal process that doesn’t require the individual to respond to the agency,” Gharst said.
Patients will be notified if the agency needs more information, and they will have 90 days to respond. Those who no longer qualify for the Oregon Health Plan or the new program, if it’s approved, will have 60 days to find another option.
The federal health insurance marketplace, which nearly 150,000 Oregonians use to find plans, offers federal subsidies to many people.
The state will send information to people about enrolling through the marketplace.
They urged current Oregon Health Plan members to keep their information up to date by checking their account through the ONE system, which processes all of the state’s benefit programs. Jake Sunderland, press secretary for the Department of Human Services, said the system has faced an onslaught of demand during the pandemic.
“It remains difficult to process applications in the timely manner people need, provide the time to explain what is changing and help connect them with their next steps, and this high level of customer service is contributing to longer wait times and raising the risk that people will experience delays or interruptions in their benefits,” Sunderland said in an email.
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