Tens of thousands of people in Central Oregon could soon find they no longer qualify for Oregon Health Plan coverage as the state begins checking their eligibility based on new income levels for 2023.
Starting April 1, the state will start sending out notices to Central Oregonians whose eligibility will be reevaluated, a process that will take place on a monthly basis through May 2024. Once notified, Oregon Health Plan members will have to reply with updated information within 90 days, and depending on their eligibility will be reenrolled, or dropped from state coverage within 60 days. Those who are dropped will have to search for a new plan.
As part of the federal response to the COVID-19 emergency in 2020, the state had expanded access to its health insurance for those who were uninsured or at risk of becoming ineligible based on household income. The move allowed more people to get coverage, increasing the number of state insured individuals from 1 million to approximately 1.5 million.
PacificSource Community Solutions, the health insurance agency in Bend that enrolls the vast majority of Central Oregonians on the Oregon Health Plan, anticipates Central Oregon could see around a third of enrollees lose coverage after they are evaluated for eligibility.
As of January, the agency had 74,820 people enrolled in the Oregon Health Plan, said Erin Fair Taylor, the vice president of Medicaid Programs for PacificSource. She said the remaining 10,211 people in Central Oregon are insured directly through the state. Fair Taylor said PacificSource anticipates 18% to 23% of Central Oregonians will be dropped from their coverage after their evaluation.
Organizations like PacificSource, Mosaic Medical, and the Council on Aging of Central Oregon are bracing for an uptick in people seeking coverage, and plan to work with the state to help people avoid gaps in their coverage.
“It could be a little bit of a stressful time for these members,” said Steve Strang, chief financial officer at Mosaic Medical, of the Central Oregonians on Medicaid. “Folks need to be paying attention and be responsive, when they get something in the mail, or they get a call from OHA, OHP or PacificSource … because it is really important. This is a really great health plan and it would be great if they could keep it.”
Strang said Mosaic supports its patients and will help people either get reenrolled or get back on new insurance if they happen to lose it.
“From Mosaic’s point of view, we are working to proactively help notify people and reenroll patients into OHP. Regardless of if they lose their insurance or not, we are here to support our patients,” Strang said.
Cassie Regimbal, the associate executive director at the Council on Aging of Central Oregon, said her organization offers a program called Senior Health Insurance Benefits Assistance, which pairs seniors with trained counselors who help get them on qualifying plans.
Regimbal said assistance programs across the state, including the one at the council on aging, are anticipating an increase in calls from people who will lose their health insurance. She said the assistance program is open year-round for anyone with questions.
“It’s really unbiased counseling. They are not trying to promote any specific plan or provider. They are just providing people with the options they would be eligible for and assisting them when someone makes a decision of what direction they want to go in terms of the medical benefits,” Regimbal said.
Amy Bacher, the health policy communications officer for the Oregon Health Authority’s Health Coverage Transformation Team, said some people will be automatically renewed with Oregon Health Plan coverage. Others who don’t qualify for renewal will be directed to possible alternatives offered on the federally subsidized insurance marketplace, Bacher said.
“The Oregon Health Insurance Marketplace will send information to people who are no longer eligible for OHP benefits, advising of potential coverage options through the marketplace,” Bacher said, “People who do not enroll through the marketplace will receive a second notice from the federal marketplace 30 days before their special enrollment period ends based on the date their OHP benefits end.”
To ensure more people remain covered, the state is pursuing a waiver to temporarily expand insurance eligibility up to 200% of the federal poverty level until the review of policy members is complete, Bacher said. An estimated 45,000 to 65,000 people should benefit from the waiver, which is expected to begin on April 1, Bacher said.
The Oregon Health Authority encourages people to update their information on the Department of Human Services benefits page or by calling 1-800-699-9075 Monday through Friday between 7 a.m. and 6 p.m.
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Joe Siess is a GA reporter for the Bulletin. Joe previously reported for the Klamath Falls Herald and News and the Malheur Enterprise. He was born and raised in the Kansas City area, and holds a master's in journalism from the University of Missouri.
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