Oregon

SCI Coverage Institute

The state legislature in Oregon has tasked the Oregon Health Fund Board with developing a plan for universal health coverage. A proposal is due for the 2009 legislative session. Coverage Institute Grant funds will pay for an actuary to assess the cost for a basic benefit package for the uninsured. In addition, Oregon will contract for a study of the impact of private market reforms, including employer requirements, a connector or health insurance exchange, and Section 125 plans. Coverage Institute Grant funds will also be used to cover a communications plan that will include internal communications between the administration and the legislature, gathering stakeholder input, and community messaging.

SCI Demonstration Grant

In 2001 the Office of Oregon Health Policy and Research was awarded a SCI Demonstration Grant. This grant was awarded to design, develop, implement and evaluate benefit and program design changes to the state's innovative Medicaid 1115 program - the Oregon Health Plan (OHP) - in 2001. The grant timeline was expedited due to the rapid nature of the waiver process and development of OHP2. The grant was completed in two years.

Oregon used the grant in two primary areas:

• The state created a two-tier benefits structure under OHP to be called OHP2. One benefit package is based on the state's prioritized list for Medicaid categorical eligibles (OHP+), and the other is a restricted package with an actuarial value of 78 percent of the current list for those eligible through the OHP demonstration program (OHP Standard).

• Since Oregon 's Family Health Insurance Assistance Program (FHIAP), a program designed to help low-income Oregonians afford private health insurance, was solely financed with state funds, Oregon worked with CMS to create a program that would conform with Medicaid and SCHIP rules to allow for the inclusion of federal matching funds. This was intended to improve the program's financial footing and allow for an eligibility expansion from 170 percent FPL to 185 percent FPL.

The waivers submitted by the state and later approved by CMS also supported the promotion of informed parental choice so that families can be covered under a single insurance policy even though different family members may be eligible for different programs. The grant had to be modified in light of severe fiscal issues. Cuts to the Oregon Health Plan, including mental health and chemical dependency benefits, were implemented in 2004 and the state struggled with how to maintain as much of OHP as possible.

Grant Highlights:

• CMS approval of OHP2 and obtained federal financial participation for FHIAP.
• Expanded coverage for pregnant women and children under age 19 from 170 percent to 185 percent.
• Established OHP standard benefit package, premium policy changes, and six-month uninsurance requirement for 100,000 adults.
• Assisted the FHIAP program with marketing/implementation of expansion up to 185 percent.
• Creation of Oregon Health Research and Evaluation Collaborative, which has produced remarkable amount of work to inform evidence-based health policy.