OHA Releases Final Policy Concept Papers for Medicaid Exemption Renewal – State of Reform


The Oregon Health Authority (OHA) on Tuesday released five final concept papers for its next renewal of Medicaid exemption. Concept papers, according to the OHA, will form the basis of the state’s 1115 waiver request to the Centers for Medicare & Medicaid Services (CMS). The new 5-year exemption will be in effect from 2022 to 2027.

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Concept papers all aim to advance health equity as part of the Oregon Health Plan (OHP). They understand:

  • Maximize OHP coverage: As part of this policy concept, the OHA aims to reduce the state’s uninsured rate from 6% to less than 2%. The agency’s other goal is to eliminate current racial and ethnic inequalities in uninsured tariffs. For example, 12% of Hispanics or Latinxes in Oregon are uninsured, compared to just 5% of white residents.

To achieve these goals, the OHA offers OHP continuous enrollment for children up to their 6e anniversary, a two-year continuous enrollment for those aged 6 and over, and an accelerated OHP enrollment path for those enrolling for SNAP benefits.

  • Stabilize transitions to minimize interruptions of care: This concept aims to better support the health of registrants through life transitions such as institutionalization changes or natural disasters. It also stresses the importance of addressing social determinants of health (SDH) such as housing, access to healthy food and employment opportunities.

The OHA says it will ask to waive federal rules that prevent Medicaid coverage for those involved in the law. The agency will request that Medicaid benefits be kept for youth in the juvenile correction system, and that a limited OHP benefit and CCO registration be provided to OHP members in prison and in the community. those within 90 days of their release from state prison.

The OHA will also apply for spending authority funding for SDOH transition services and infrastructure needs.

  • Flexible and value-based overall budget: State seeks authorization to create global value-based budgets for CCOs which, according to the OHA, “will provide longer term predictability and flexibility to CCOs and suppliers, in turn resulting in investment additional upstream in prevention and health-related services to improve health outcomes and reduce avoidable health care costs.

Global budgets would “further reverse financial incentives” and encourage CCOs to invest in health outcomes, social determinants and health equity for members, the concept paper reads.

To meet these goals, Oregon will seek approval to calculate an adequate base budget for covered services, establish a predictable rate of growth, and more closely manage drugstore costs.

  • Encourage equitable care: To focus more directly on equitable care, the OHA intends to restructure its quality incentive program by putting in place upstream measures focused on health equity and adding downstream measures focused on quality and access measures. This concept paper also states that the OHA intends to “redistribute decision-making power among communities”.

  • Targeted equity investments: With this concept paper, the OHA intends to call on the federal government to invest in community initiatives aimed at improving the health of those most affected by inequalities. These investments, according to the agency, will create downstream cost savings for the federal government and the state.

To implement the investment, the OHA is seeking federal matching funds for SDOH transition services and authorization to account for ACO’s investments in health equity as medical claims for the establishment of prices.

“The OHA is proud of the vision these policy documents represent – a vision for a more equitable, responsive and community-based Medicaid system,” OHA Director Patrick Allen said in a statement. “We believe that this vision, which we have achieved with extensive community input, will lead to significant improvements in community health, put more resources and decision-making power in the hands of the community, and dramatically improve member services. individual OHP when needed. . In short, this is a powerful proposition to the federal government to steer our Medicaid system towards health equity. “

The OHA plans to publish the draft application on December 1 and begin a formal public comment period on December 7. The comments will be incorporated into a final request that the agency plans to submit to CMS by February 2022.

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