The state is the third nationwide to expand coverage to people who earn more than limits set by the federal government

By Lynne Terry, Oregon Capital Chronicle

After two years of planning, Oregon is officially expanding its Medicaid program to give tens of thousands of more people access to the free health insurance program. 

The Oregon Health Authority announced on July 1 the launch of its OHP Bridge Plan to those who earn more than the federal limits for traditional Medicaid. The Oregon Health Plan, the state’s version of Medicaid, currently covers 1.4 million Oregonians who earn up to 138% of the federal poverty level, or nearly $21,000 a year for one person or more than $43,000 a year for a family of four.

The OHP Bridge is extending Medicaid benefits to those who earn up to 200% of the federal poverty level. That means that individuals who earn about $30,000 a year or families of four who earn $62,400 a year will qualify.

Oregon Health Authority officials expect the plan to cover 100,000 Oregonians by 2027.

Dr. Sejal Hathi, director of the health authority, said in a news conference the plan marks a “significant milestone” in Oregon and will help eliminate health inequities, a health authority goal. 

“We know that these higher rates of coverage are associated with better health outcomes, with greater health care access and with fewer health inequities, and we want to keep it that way,” Hathi said.

Oregon is the third state nationwide — after Minnesota and New York — to expand Medicaid to beyond the traditional federal income limits. But it’s the first state to offer that coverage at no cost, without monthly premiums or co-pays. 

“We know that cost sharing in any form, whether that’s premiums or co-pays, is a barrier to care for people in this income range, and were we to have either or both of those, we would actually see decreased access to care, which is counterproductive for the goals of the state,” said state Sen. Elizabeth Steiner, a medical doctor and one of the lawmakers who developed the bridge plan.

Like those on Medicaid, people who qualify for the bridge plan will enjoy free medical, dental and mental health care along with some other benefits, such as transportation to medical appointments. 

“This means that more people will be able to get the diagnoses, treatment and other services they need, preventing delays and care that nearly 300,000 Oregonians otherwise report due to costs,” Hathi said. 

Gil Muñoz, chief executive officer of Virginia Garcia Memorial Health Center, which serves many Medicaid patients in Forest Grove, said during the news conference that the plan is a win for working families who have a tough time paying for housing, food, transportation and child care. He said it’s also a boon for providers to work with lower-income families to get them diagnostic services, specialist care and hospital treatment that they need.

“It eases the path to better health and better prevention for these families,” Muñoz said.

Federal approval

Oregon won approval from the federal Centers for Medicare and Medicaid Services to offer the plan under a Medicaid waiver. That approval means that the federal government will pay much of the cost of the plan, diverting money that it would normally pay in subsidies to people who otherwise would buy health insurance on the federal marketplace. The state will pay the remaining cost. 

Under traditional Medicaid, the federal government picks up about 60% of the cost, and Oregon pays the rest. Payments for the bridge plan will work differently, with the federal government depositing money into an account and the state reconciling that later. Erica Heartquist, a health authority spokeswoman, said the state estimates that Oregon will receive about $500 million in federal revenue to cover an average of 65,000 members per month over the next 12 months. The state is likely to spend $10 million to administer the program and cover costs not paid for by federal funds. 

Health officials say keeping people covered is cheaper in the end because they take care of basic problems early or even before they start by regularly seeing a primary care provider and receiving preventive care, like cancer screenings and blood tests that track cholesterol and diabetes risk. Those without insurance often wait until a health problem worsens until they’re severely ill and care is more expensive or seek treatment in an emergency room, which is the most expensive kind of care and drives up overall health care costs.

“The basic health plan, OHP Bridge, is a great deal for Oregon taxpayers,” Hathi said.

The plan has been in the works in Oregon for two years, following passage of House Bill 4035 during the 2022 session, which launched a task force to develop the plan. One of the plan’s biggest targets is to cover people who’ve recently lost Medicaid coverage. During the pandemic, the federal government provided extra benefits to states that kept people enrolled, regardless of any income changes. That meant that even when people’s income changed and they technically no longer met the limit, they enjoyed the free coverage.

But last spring, that changed when the federal government ended the program. Since then state officials have gone through the Medicaid rolls, making sure that everyone on Medicaid qualifies. In Oregon, more than 80% of those covered kept the insurance — one of the highest rates in the country, according to an analysis by KFF Health News. 

About 222,000 have fallen off, and state officials have pointed them to the federal marketplace to buy individual coverage. Hathi said that up to 30,000 people who stayed on Medicaid during the pandemic but no longer qualify will be moved to the bridge plan because they qualify under the bridge plan’s income limits.

Though they will enjoy most Medicaid benefits, those on the bridge plan will not qualify for long-term care, nor will they be able to obtain social services that were approved under a CMS waiver to improve the environment of Medicaid patients. Under the waiver, Oregon can offer climate support, such as a free air conditioner or air filter, to help patients cope with extreme weather events and wildfire smoke; housing support for up to six months; and nutrition education and food assistance.

Officials rolled out the climate benefit this spring, though fewer patients are getting air conditioners than originally hoped. The housing benefit is expected to be offered toward the end of the year and the food benefit after that.

Lynne Terry has more than 30 years of journalism experience, including a recent stint as editor of The Lund Report, a highly regarded health news site. She reported on health and food safety in her 18 years at The Oregonian, was a senior producer at Oregon Public Broadcasting and Paris correspondent for National Public Radio for nine years.