CORE studies successes and challenges in expanding Medicaid eligibility

CORE studies successes and challenges in expanding Medicaid eligibility

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  • In 2021, Oregon House Bill 3352 paved the way for a new program that allows more people to access full Oregon Health Plan (OHP) benefits, regardless of their immigration status.
  • As of November 2022, more than 14,300 people had enrolled in OHP via Healthier Oregon.
  • Research by Providence CORE is looking at how local Coordinated Care Organizations (CCOs) are managing this rollout, as well as ways to prepare and improve for the future.  

In 2021, the passage of Oregon House Bill 3352 paved the way for a new program that allows more people to access full Oregon Health Plan (OHP) benefits, regardless of their immigration status. This pathway, now known as Healthier Oregon, allows those up to age 26, or 55 and older, to enroll in this Medicaid-like benefit if they meet specific income criteria and other requirements but don’t qualify for full OHP benefits because of their immigration status.  

As of November 2022, more than 14,300 people had enrolled in OHP via Healthier Oregon. Researchers at the Providence Center for Outcomes Research and Education (CORE) began studying the program rollout around the same time. Building on CORE’s long history of studying OHP and its impacts, the Healthier Oregon Qualitative Study seeks to understand how Oregon’s Coordinated Care Organizations (CCOs) are managing this rollout and ways that the state and the CCOs that serve Oregonians on Medicaid can prepare and improve for the future.  

While this research is ongoing, initial findings highlight several ways that health systems can better prepare for expanding Medicaid eligibility to underserved populations. 

Initial observations from the Healthier Oregon Qualitative Study 

  • Oregon’s CCOs were generally hesitant to make assumptions about future enrollees’ specific needs. However, they expect the program to drive increased demand for healthcare services and a need for additional support to help these new members navigate healthcare services. 

“We’ve suspended a lot of expectations because I think we don’t know enough to make assumptions. It was really more just ‘how can we be responsive to whatever the needs, questions or kinds of services people are seeking'" – CCO interviewee 

  • Past research has shown that Community-Based Organizations (CBOs) can serve as a valuable link between community members and health providers. In the case of the Healthier Oregon rollout, CBOs are considered crucial. CBOs were found to play an essential role in navigation and client communication due to their trusted role in the community. This highlights the importance of collaborating with CBOs in implementing healthcare programs. Today, the Oregon Health Authority funds more than 20 community-based groups to provide culturally and linguistically responsive enrollment support and navigation. 

  • While CCOs voiced concerns about the capacity and systems required to serve a large number of new members and connect them to care in a timely manner, those concerns are not unique to this specific population. Interviewees highlighted a need to focus on ensuring continuity of care for new OHP members who were receiving health care services through other programs, concerns about the existing behavioral health care provider shortage’s impacts on these new members, and the challenges in recruiting and retaining providers from culturally specific groups.  

“Our priority over the last four months has really been communicating access, making sure that HOP members know what they have access to… rights, covered services, case management, care coordination… if our efforts are working, we should see that on the utilization side.” – CCO interviewee 

Overall, the Healthier Oregon Qualitative Study is expected to provide actionable insights into the rollout of the HOP program and the challenges and successes experienced by CCOs. Once the study is completed in 2023, findings will be used to improve the program and can help inform the development of similar programs in other states.  

CORE’s research to date also raises other important questions that need to be addressed, such as understanding healthcare utilization among new Healthier Oregon enrollees and the extent to which continuity of care is supported. It is essential to monitor the program and address any issues that arise to ensure that HOP enrollees receive the best possible care.  

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