For the first time since freezing enrollment in 2004, Oregon's Department of Human Services has begun enrolling new members into its Oregon Health Plan Standard (OHP Standard) program. The program, which provides a limited benefit package for low-income adults who do not qualify for traditional Medicaid, had stopped enrolling new members due to severe budgetary shortfalls. [1] To ensure fairness in the application process, the state began a reservation list on January 28 and invited uninsured individuals to submit their names. Beginning in March, 3,000 names will be randomly chosen each month to receive an application to enroll in the program. Currently, OHP Standard serves 18,000 members; administrators aim to reach an average enrollment of 24,000 members.
When the OHP Standard benefit package was created through a Section 1115 waiver in February 2003, the goal was to expand coverage to the non-traditional Medicaid population—parents and adults without dependent children—but provide fewer benefits. At that time, the program covered approximately 90,000 individuals with income below 100 percent of the FPL. Under the new waiver, Oregon planned to incrementally expand eligibility to higher income levels.
Because of budget shortfalls, the planned expansion did not occur. Instead, a number of policies led to a precipitous decline in enrollment. These included cost-sharing and premium requirements imposed on all enrollees, and disenrollment with a six-month "lock-out" for failure to pay premiums. In addition, one month after its implementation, the state eliminated dental care, medical supplies, outpatient mental health, and outpatient chemical dependency services from the benefit package, reducing the program's appeal. One year after implementation, the legislature eliminated state general funds as a funding source for the program, leading to the freeze in 2004, with enrollment at 24,000. [2] Through attrition, enrollment has further declined to 18,000 individuals.
Oregon has since established a new funding source for OHP Standard—a tax on hospitals and health plans—thereby permitting the state to build membership back to 24,000. Since the state anticipates that there will be greater demand than funding will permit, it selected the lottery as the fairest way to carry out further enrollment. Karen House, Oregon's Department of Human Services Medical Program Manager, explains: "According to an independent evaluation, the random selection process provides the most equitable method to enroll new clients, given that many more people qualify than the number of openings available."
The OHP standard program no longer requires copayments, and premiums have been eliminated for the lowest-income enrollees, making it a more attractive option for uninsured individuals. The benefit package includes chemical dependency services, mental health services, and limited dental services.
Eligible individuals may request to be placed on a reservation list either in person at a Department of Human Services (DHS) office or by telephone, internet, e-mail, fax, or mail. The list will be closed on February 29. Names will be drawn at random, and those individuals will receive an application from the DHS, which must be returned within 30 days. Plan eligibility will be verified from those applications. In an effort to publicize the reopening of the OHP Standard program to new enrollees, the state embarked on a comprehensive outreach and awareness campaign. In addition to making materials about the reservation list and lottery available at DHS offices, county health departments, and most major hospitals and clinics, the state also mailed brochures to 330,000 households that already receive DHS benefits, and sent other promotional materials to more than 1,800 community partners. Materials were printed in 10 languages to further expand the campaign's reach. While DHS regrets that it will not be able to enroll all who may qualify for OHP Standard, it believes it is making an impact on the number of uninsured through this process.
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References
[1] A number of factors contributed to the economic downturn that resulted in budget shortfalls, including a rising unemployment rate and a 19 percent decline in personal income tax revenues between 2002 and 2003 (J. Oberlander, Health Reform Interrupted: The Unraveling of the Oregon Health Plan, Health Affairs Web Exclusive, December 19, 2006).
[2] Memo from Office of State Senator Avel Gordly, Senate District 23, January 13, 2008, http://www.leg.state.or.us/gordly/newsletter_011408.htm.
