Medicaid eligibility and enrollment in Oregon

Many Medicare beneficiaries receive Medicaid’s help with paying for Medicare premiums, affording prescription drug costs, and covering expenses not reimbursed by Medicare – such as long-term care.

Our guide to financial assistance for Medicare enrollees in Oregon includes overviews of these benefits, including Medicare Savings Programs, long-term care coverage, and eligibility guidelines for assistance.

Oregon is working to create a Basic Health Program, which will cover people with income between 138% and 200% of the poverty level. But Oregon has also temporarily further expanded Medicaid, up to 200% of the poverty level, to adults who were enrolled under Medicaid expansion during the pandemic.

Until the BHP is up and running (expected to be the summer of 2024), this unique approach helps to prevent coverage losses during the “unwinding” of the COVID-related continuous coverage rule. Without the temporary additional Medicaid expansion, the state estimated that 300,000 people would have lost coverage during the unwinding period. But that number will be lower now that the state is temporarily allowing adult Medicaid enrollees to continue to be covered by Oregon Health Plan with income as high as 200% of the poverty level.

Oregon’s approach, (via an approved amendment to an existing 1115 waiver) temporarily allows people age 19-64 to stay on Medicaid if their income isn’t more than 200% of the poverty level, assuming they would otherwise have become ineligible for Medicaid due to their income (ie, their income has risen above 138% of the poverty level, but doesn’t exceed 200%).

In Oregon, Medicaid disenrollments resume at the end of July, or at the end of September for members who don’t respond to their renewal packet.

For people who end up needing to purchase their own replacement coverage (ie, they lose Medicaid and aren’t eligible for Medicare or an employer’s plan), HealthCare.gov is offering an extended enrollment opportunity, from March 31, 2023 through July 31, 2024, for anyone who loses Medicaid at any time during that window. Oregon uses HealthCare.gov as its marketplace/exchange, so this enrollment window will be available to Oregon residents who lose Medicaid during the “unwinding” of the pandemic-related continuous coverage requirement.

An 1115 waiver, effective October 2022 and valid through September 2027, is allowing Oregon to provide residents with longer stretches of continuous Medicaid coverage. Under the terms of the waiver:

• If a child under age six is determined eligible for Medicaid, they will stay eligible until they turn six, even if their circumstances (family income, etc.) change in a way that would otherwise make them ineligible.
• For people six and older who are determined eligible for Medicaid, they will stay eligible for at least 24 months, even if their circumstances change in a way that would otherwise make them ineligible.
• Young adults (19-26) with special health care needs are eligible for Medicaid with income up to 300% of the poverty level.

Nationwide, Medicaid eligibility was continuous from March 2020 through march 2023, due to the COVID pandemic, although routine eligibility redeterminations resumed in April 2023. And starting in 2024, all states will have to provide at least 12 months of continuous eligibility for children who are determined eligible for Medicaid, even if their circumstances change.

But Oregon’s 1115 waiver allows the state to go well beyond the minimum requirements, ensuring that people maintain continuous coverage and reduce the “churn” that happens when people transition in and out of the Medicaid system due to frequent eligibility changes.

Prior to 2014, it was anticipated that Oregon would enroll 400,000 new members in the Medicaid program by 2022. While that prediction may ultimately prove accurate, Medicaid enrollment in Oregon has fluctuated rather dramatically from the launch of the ACA and Medicaid expansion.

In the fall of 2013, prior to the launch of the ACA’s exchanges, Oregon’s total Medicaid/CHIP enrollment stood at more than 626,000.

By March 2016, enrollment in Oregon Medicaid/CHIP was 1,076,961 (a 72% increase compared to 2013 enrollment, which was at that point tied with Colorado for the third highest percentage growth in the country, behind only Kentucky and Nevada).

Then, Oregon Medicaid enrollment dropped sharply from early 2016 to early 2017. Not coincidentally, Oregon had experienced glitches with its Medicaid enrollment platform prior to 2016, and applicants’ eligibility had not been properly screened. Between March 2016 and August 2017, nearly 300,000 enrollees were removed from the Medicaid program once it was determined that they weren’t actually eligible for benefits.

By June 2018, Oregon Medicaid/CHIP enrollment had rebounded to more than 963,000 people. Enrollment grew by more than 100,000 people between then and July 2020, when it reached more than 1,066,000 people. By May 2023, enrollment stood at more than 1.5 million. This was after three years of continuous eligibility for everyone who had been enrolled as of March 2020, when periodic eligibility redeterminations were paused under the federal Families First Coronavirus Response Act.

Oregon is one of a handful of states that used a fast-track enrollment process prior to 2014 that let them identify Medicaid-eligible residents based on their participation in other state-run programs. Since their income and immigration status were already verified, the people who were identified as fast-track eligible did not have to go through the full application process for Medicaid.

The state sent out notifications to about 300,000 residents, letting them know they were eligible for Medicaid. People who received one of these letters were able to simply fill out the enclosed form and returned it in the postage-paid envelope to be automatically enrolled in Medicaid. Oregon also had a system that let eligible fast-track enrollees complete the enrollment process by telephone.

The Oregon Health Plan is Oregon’s Medicaid program, overseen by the Oregon Health Authority.  The Oregon Health Plan was conceived and implemented in the late 80s and early 90s. Oregon Medicaid was on the cutting edge of health care reform, addressing the issue of access to healthcare long before most other states.

During that time, physician John Kitzhaber was a state senator and was instrumental in shaping Oregon’s Medicaid program. Kitzhaber went on to be governor of Oregon from 2011 to 2015. During the late 80s/early 90s, Oregon’s uninsured rate was about 18%. According to a Gallup data, that rate had dropped to 14% by mid-2014, and to just 8.8% by mid-2015. That put Oregon third in the nation in terms of percentage drop in the uninsured rate by the first half of 2015.

In 1994, Oregon expanded Medicaid to cover all residents with incomes below the poverty level under a basic benefits package (OHP Standard, as opposed to the OHP Plus program that applies to pregnant women, children, disabled residents, and others who were already eligible for Medicaid). That year, 120,000 newly-eligible residents enrolled, and Portland area hospitals saw a 16% reduction in unpaid medical bills.

In 1995, Medicaid in Oregon began to add mental health and chemical dependency coverage, although these services were removed from the basic benefits package in 2003. In most states, Medicaid was only available to pregnant women, children, seniors, and adults with disabilities prior to 2014 — Oregon was way ahead of its time in expanding basic coverage to everyone living in poverty.

Over the last two decades, Oregon Health Plan has instituted numerous cost-containment measures, including a requirement that limits beneficiaries to a single pharmacy (chosen by the insured member), a disease management program providing case management to clients with specific chronic illnesses, and copays for most adult clients who are not part of exempt groups (tribal members, pregnant women, etc.). Coverage for vision/hearing, and durable medical equipment was eventually discontinued as the state worked to reduce Medicaid expenses.

In addition, the state began requiring small premiums to participate in OHP Standard, and that led to roughly 40,000 enrollees dropping their coverage because they were unable to pay the premiums (now that Medicaid has been expanded, they are once again eligible for coverage without premiums).

By 2004, considerable budget issues led to a ballot initiative that would have generated revenue for OHP via additional income taxes, corporate taxes, and tobacco taxes.  The ballot measure failed though, and OHP Standard ceased new enrollments on July 1, 2004.  It didn’t open back up again until 2008, at which point there was a lottery to claim 3,000 available spots in the program (tens of thousands of people applied to get one of the spots, and many people applied more than once over the ensuing years).

It was a natural progression for Oregon to accept federal funding to expand Medicaid in 2014.  Coverage is now available for all legally present residents with incomes up to 138% of poverty, and the federal government is picking up most of the tab for the newly-eligible enrollees. There’s no longer a lottery system in Oregon — everyone who qualifies can enroll in the program. The Oregon legislature passed an omnibus bill early in 2014 that increased Oregon Health Plan’s budget by $1.17 billion (to a total of $14.4 billion) for 2013 – 2015, in order to get the Medicaid expansion program up and running.