Federal Government approves Oregon Medicaid waiver

News release from Oregon Health Authority

SALEM – Today (Wednesday), Oregon received federal approval to pilot first-in-the-nation changes to the state’s Medicaid program over the next five years. Under the agreement, Oregon would receive $1.1 billion in new federal funds to address inadequate food, housing and other root-cause issues that lead to poor health for people and families struggling to make ends meet. As part of the agreement, the federal government also approved expanded Oregon Health Plan (OHP) coverage for young children, as well as extended eligibility for youth and adults.

The Oregon Health Plan, which is Oregon’s Medicaid program, provides comprehensive health coverage to approximately 1.4 million Oregonians, more than one in three state residents. States may request federal approval to test innovations in their Medicaid programs. Today’s agreement between Oregon and the federal agency Centers for Medicare & Medicaid Services (CMS) renews Oregon’s current section 1115 Medicaid Demonstration Waiver for the next five years (covering 2022 – 2027) and provides federal sign-off and funding to implement the new changes.

A state must apply for a Medicaid waiver when it wants to make changes from normal federal guidelines. States can request flexibilities in who is eligible for Medicaid, what benefits they receive and how health care is delivered.

 “I’m proud to work alongside Oregon to advance policies to expand access to high-quality health care, particularly for those most in need,” said Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure. “Thanks to this demonstration, for example, eligible children in Oregon will be able to keep their Medicaid coverage continuously until age 6, eliminating potential gaps in coverage and care. The demonstration also invests in the services that people need to address their health-related social needs, such as medically tailored meals and housing supports. That is transformational change – as are many of the other components included in Oregon’s 1115 demonstration. We encourage all states to follow Oregon’s lead supporting a whole-person approach to care.”

Extended health coverage for children, special needs youth and adults

Oregon’s renewed waiver will allow the state to keep children enrolled in Medicaid up to age 6 — preventing gaps in coverage that can cause children to lose access to needed care in their formative early years. Oregon is the first state in the nation to receive federal approval for continuous health coverage for children under 6 years old.

Also, all OHP members age 6 and older will have two years of continuous OHP enrollment. Establishing longer continuous coverage periods will keep more Oregonians enrolled in OHP with consistent access to health, dental, and behavioral health care.

Medicaid coverage to address hunger, homelessness and climate change

In another first-in-the nation innovation, Oregon will expand health-related social needs coverage for certain food assistance, housing supports and other interventions that are medically appropriate for individuals experiencing certain life transitions, including individuals who are homeless or at risk of homelessness.

This package of services, called health-related social needs, includes food and housing supports (including rental assistance) for up to six months for groups who have been marginalized such as youth in foster care, people who are homeless and low-income older adults. State health officials sought federal approval to cover housing and nutritional support services to reduce health inequity and stabilize the circumstances of OHP members who are at-risk of worsening health during major life disruptions. In addition, Oregon will provide devices – air conditioners, air filters, generators – to people with a high-risk clinical need who reside in regions experiencing extreme weather events that place the health and safety of residents in jeopardy as declared by the federal government or the governor of Oregon.

“Oregon is committed to eliminating health inequity and ensuring that our health care system provides optimal health and well-being for everyone in Oregon,” said OHA Director Pat Allen. “This agreement gives us more tools and resources to tackle the problems in people’s lives that undermine their health such as lack of housing, food or consistent health coverage. We’re excited to work with partners in every corner of the state to help more people in Oregon live healthier lives, hold down the growth of health care costs and strengthen communities across our state.”

Expanding health services for children and youth with special needs

Under the new five-year Medicaid waiver, Oregon will cover early periodic screening, diagnosis and treatment (EPSDT) services for to all children and youth up to age 21 and for youth with special health care needs up to age 26, effective Jan. 1, 2023. Under the new waiver, the federal government will allow Oregon to expand Medicaid eligibility and benefits for youth with special health care needs up to the age of 26 if their income levels are at or below 300% of the federal poverty level (FPL). This will ease their transition to adulthood, with fewer disruptions in health care and services.

Federal government commits $1.1 billion to address health-related services, expand coverage and improve care

Oregon also received significant federal support through Designated State Health Programs (DSHP) totaling $1.1 billion in federal funds over the waiver period. Under the waiver, Oregon will use these funds to address health-related special needs (such as housing, food and climate related supports), increase health coverage, achieve better health outcomes and improve the efficiency and quality of care.

In addition, the new waiver sets a timeline to move Oregon’s prioritized list of services from a demonstration to the State Plan as part of standard benefits and services.

Pending decisions

Along with today’s waiver approval, Oregon and CMS will continue to discuss Oregon’s proposals to have new Community Investment Collaboratives (CIC) throughout the state manage community-led health equity interventions. State and federal health officials also will continue to discuss OHP coverage for youth in detention and adults in jails, as well as 90-day transitional pre-release coverage for adults in prison or psychiatric facilities.

Oregon health officials also requested authority to remove prior authorization requirements for American Indians/Alaska Natives on OHP, convert the Special Diabetes Program for Indians to a Medicaid benefit, reimburse tribal-based practices and extend coverage of new health-related social need services to tribal members not enrolled in a Coordinated Care Organization. Federal officials are continuing to evaluate Oregon’s request.

To learn more about all the changes being implemented in the Medicaid waiver and other related efforts in Oregon to transform our health system, visit here.

2022 – 2027 Medicaid Demonstration Waiver Policy Summary

Oregon Health Plan Section 1115 Demonstration Approval

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