Up to 30,000 people now, and 100,000 people eventually, will continue under state-supported health insurance for low-income households as part of a new Oregon Health Plan extension announced this week.
The extension is known as the OHP Bridge Plan. It was announced Monday, July 1, by state officials, the top federal official for Medicaid — the joint program of health insurance for low-income people — and the chief executive of Virginia Garcia Memorial Health Center, which serves low-income people through 18 clinics in Washington and Yamhill counties.
The extension is budgeted for one year through June 2025.
While the Oregon Health Plan is synonymous with Medicaid, some of the same federal dollars also pay for longterm care — not covered by Medicare — for low-income older people who spend down their assets.
The new plan is aimed at keeping people insured as Oregon and other states, following a federal requirement, review the eligibility of current recipients for Medicaid coverage. At the onset of the coronavirus pandemic in 2020, states were barred from removing people from Medicaid enrollment. But those restrictions were lifted at the start of this year.
The plan is intended to maintain coverage for Oregon households between 138% and 200% of the federal poverty level, at the upper reaches of eligibility for Medicaid. For one person, based on the 2024 family income level, that range is between $20,783 and $30,130. For a family of four, the range is between $43,056 and $62,400.
This group of people is least likely to afford individual coverage under the federal insurance marketplace, even with federal subsidies that help people pay premiums.
Dr. Sejal Hathi, director of the Oregon Health Authority, said the initial enrollment in the new bridge plan is expected to be between 25,000 and 30,000 — and there is room for the ultimate target of 100,000.
If they had been forced to drop coverage, those uninsured households would have reduced Oregon’s insured rate of 94% by several points.
“We feel these higher rates of coverage are associated with better health outcomes and greater health access,” Hathi said. “And we want to keep it that way.”
Recipients under the new plan will not have to pay monthly premiums or share in the cost of covered services through copayments and deductibles.
Medicaid became the Oregon Health Plan in 1994, after legislative approval in 1989 of the Oregon Health Plan, which matched medical treatments and services with their effectiveness on patients. With a previous expansion following federal legislation in 2010, the plan now enrolls 1.4 million people — one-third of Oregon's population.
Maintaining coverage
“One of the reasons Oregon’s redetermination process has gone so smoothly and resulted in so little loss of coverage is because we were committed to maintain (coverage of) people in this income range,” state Sen. Elizabeth Steiner, a Democrat from Portland and a family-practice physician, said.
“So I’m excited to see this part move forward to ensure that Oregonians across the state, regardless of income, have access to high quality, affordable upstream care.
“We know there will be other people who are not on Medicaid in this income range,” she added. “There will be outreach to ensure that they are aware they can enroll through the one-eligibility system in this program.”
Gil Muñoz is chief executive of Virginia Garcia Memorial Health Center, whose staff helped an estimated 37,000 Oregonians maintain their state insurance coverage while providing services. He said one of his organization’s continuing tasks will be to help eligible people transition to the OHP Bridge Plan.
“This extension of the program is a win for patients and working families who are challenged to make ends meet with housing, child care and transportation costs,” Muñoz said. “Providing coverage provides some relief from the stresses they face. It eases the path to better health for these families.”
Multnomah County is roughly at the state average with 33.8% enrollment in the Oregon Health Plan in May. Washington County was at 25.2% and Clackamas County at 24.4%. The largest shares were in rural counties of Eastern, Central and Southern Oregon: Malheur at 51.1%, Jefferson at 47.6% and Josephine at 46.7%.
“This kind of churn — access to health care, then no access to health care — is not good for people’s well-being,” Steiner said. “It’s stressful. It increases anxiety. It reduces the likelihood of managing chronic disease as well.”
Budget implications
Steiner said the new plan has been in the works for at least two years and is accounted for in Oregon’s current two-year budget cycle. The budget lists a total of $661 million, most of it from federal funds, for what it calls the Basic Health Plan, now “Bridge.”
Steiner co-led a task force with then-Rep. Rachel Prusak, a Democrat from West Linn and a nurse practitioner who left the House in 2023 after two terms. (Prusak was appointed a year ago as executive director of the Oregon Board of Nursing.)
After more than five years as Senate co-chair of the Oregon Legislature’s joint budget committee, Steiner — now the Democratic nominee for state treasurer — is leaving that position on July 15.
During the pandemic and previous economic downturns, the federal share of Medicaid went up and state shares went down. This time, the federal share will go down and state shares will go up. It’s roughly 60% federal, 40% for the states, but each state has a different formula.
The latest change will cost Oregon $889.6 million more from the state’s tax-supported general fund, though a change in federal projected rates may result in Oregon paying a little less during the current two-year budget period.
An additional $881.6 million in the budget, $120.2 million of it from state funds and the rest from federal funds, will maintain continuous Oregon Health Plan coverage for children under age 6 and two-year coverage for children between ages 6 and 17. Oregon’s waiver from Medicaid requires this type of support through 2027.
Federal flexibility
Under Section 1115 of the Affordable Care Act in 2010, a provision inserted by U.S. Sen. Ron Wyden of Oregon, states have more flexibility in federal waivers for how they spend Medicaid dollars.
As deputy administrator for Medicaid and Children’s Health Insurance Program services, Daniel Tsai is the top Medicaid official in the Centers for Medicare and Medicaid Services, part of the U.S. Department of Health and Human Services. He came to that job from running the Medicaid program in Massachusetts.
He told reporters on a conference call:
“If a state wants to run a program like this, which is innovative and meets a set of minimum standards that involve robust coverage, the federal government is able to provide 95% of what the federal subsidies otherwise would be for these individuals if they were enrolled in the marketplace.”
According to the 2023-25 state budget analysis, Oregon stands to receive a total of $661 million for the new program through mid-2025, $51.6 million of it from the tax-supported general fund, the rest from federal grants.
Minnesota and New York have similar programs.
“Oregon has been an innovative partner in helping reduce administrative barriers that prevent people from maintaining coverage,” Tsai said. “This approach to OHP helps smooth that.”
pwong@pamplinmedia.com
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