OHA releases final policy concepts for Medicaid waiver

Proposals focus Oregon Health Plan on health equity

PORTLAND, Ore.—Oregon Health Authority has published final policy concepts that will be the basis of an application to the federal government to focus the Oregon Health Plan on achieving health equity.

The five policy concept papers, linked below and released today, present a shared vision from a diverse range of health care and community voices for changes to the Medicaid system – often referred to as the Oregon Health Plan (OHP). OHA staff gathered this wide-ranging input and distilled these recommendations into a set of proposals the state will discuss with federal health officials.

OHA will conduct a formal public comment period starting Dec. 7, during which input is welcome on both the policy concepts and a formal application to the federal government. The application will be released in advance of the comment period. Planned opportunities for public comment are outlined below.

“OHA is proud of the vision that these policy papers represent – a vision for a more equitable, responsive and community-focused Medicaid system,” said OHA Director Patrick Allen. “We believe this vision, which we arrived at with extensive community input, will lead to significant improvements in community health, put more resources and decision-making power in the hands of community, and greatly enhance services to individual OHP members in times of need. In short, this is a powerful proposal to the federal government to orient our Medicaid system toward health equity.”

The policy concept papers are linked below with a short summary. All documents are available in 12 languages on OHA’s 1115 Demonstration Waiver renewal webpage.

Maximizing continuous and equitable access to coverage 

It is only with continuous and equitable access to health insurance that people can access the care they need to stay healthy. OHA knows that people of color and communities most harmed by social injustices have lower health insurance rates. This approach will seek to eliminate inequitable access with strategies to extend coverage and services to every eligible child and adult in Oregon. READ MORE

Improving health outcomes by streamlining life and coverage transitions

Data show members of high-risk populations often lose coverage and access to care during life transitions and in transitions between systems, like incarceration or the state hospital. These disruptions come at great cost to the individual and to the system. By providing specific benefit packages, including extending eligibility to members in transition, we can ensure they stay covered, have important social determinants of health needs met and maintain access to care and medicine, which ultimately improves health outcomes. READ MORE

Moving to a value-based global budget  

Compared with other states, Oregon has generated large savings from our approach to Medicaid. Our CCO model is both innovative and cost-effective. To maintain and build on our successes, we must continue to build a system that rewards spending on health equity and improving the health of communities rather than spending on medical procedures and services alone. READ MORE

Incentivizing Equitable Care

Oregon’s coordinated care model is built on incentivizing quality and access. OHP members and community members have continued to tell us that equity must be the focus across the system. OHA will revise our CCO metrics to focus on traditional quality and access for downstream health and also create a new set of equity-driven CCO performance metrics for upstream health factors. By taking these steps we can make significant progress in driving the system toward more equitable health outcomes. READ MORE

Improving health through focused equity investments led by communities

Oregon’s Medicaid system can do more to invest in community-based approaches to address social determinants of health that cause health inequity. With focused equity investments, Oregon will redistribute both funds and decision-making power to local communities. With this focus on community-driven solutions, OHA believes we can use funding to better address larger scale barriers to health and health equity. READ MORE

In addition to these policies, OHA is committed to working with the nine federally recognized Tribes of Oregon, and the Urban Indian Health Program (UIHP) to identify mechanisms to help ensure Tribal health care objectives are achieved, while honoring traditional Tribal practices and upholding the government-to-government relationship between the sovereign nations and the state.

Opportunities for input:

OHA welcomes feedback on the policy concept papers at any time via email at 1115.WaiverRenewal@dhsoha.state.or.us. In December, OHA will conduct a formal public comment period on the waiver application, which is based on the policies outlined in its policy concept papers. As of today, the following meetings will be open for public comment on the waiver application. A full calendar of public meetings is available on our webpage Oregon.gov/1115WaiverRenewal.