Oregon Health Plan

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The Oregon Health Plan is Oregon's state Medicaid program. It is overseen by the Oregon Health Authority.

History[edit]

The Oregon Health Plan was conceived and realized in 1993 by emergency room doctor (and current Oregon governor) John Kitzhaber, then a state senator,[1] and Dr. Ralph Crawshaw, a Portland activist.[2] It was intended to make health care more available to the working poor, while rationing benefits.[1] During the 1990s, Oregon was considered a national leader in health care reform.[3]

The law passed in Oregon was not initially compatible with federal law, so a waiver was needed. President Bill Clinton approved the plan on March 20, 1993, though he required a revision to the plan due to a concern about whether disabled people would have equal access.[4] At the time, Medicaid covered 240,000 Oregonians.[4]In 1994, the plan's first year of operation, nearly 120,000 new members signed up, and bad debts at Portland hospitals dropped 16%.[1]

The cost of the Oregon Health Plan increased from $1.33 billion in 1993-1995 to $2.36 billion in 1999-2001, leading to budget-tightening measures in the early 2000s;[1] significant cuts would follow in 2003.[5]

New enrollment in the program was closed from mid-2004[6] until early 2008, when a lottery-based system was introduced. Tens of thousands of Oregonians signed up, competing for 3,000 new spots in the plan.[7][8] In 2008, the Oregon Health Authority began implementing changes to Medicaid policy to increase screening rates and provide more access to services for young children at risk of developmental disorders. Some of these changes included revising certification requirements for patient-centered medical home (PCMH) status to include developmental screenings for children at the 9-month, 18-month, and 30-month well-child visits.[9]

The Oregon Health Plan was expanded to cover 80,000 uninsured children through legislation that passed in 2009. [10] The program has enrolled 38,000 additional children through February, 2010. [11] As of 2012, there are more than 100,000 children enrolled.

Oregon's proposed Oregon Health Plan (Medicaid) transformation was initiated by Oregon House Bill 3650, which was passed by the state Legislature with bi-partisan support in June 2011. In March, Oregon Senate Bill 1580 was signed into law by Governor John Kitzhaber establishing Coordinated Care Organizations, which will focus on prevention and coordination of physical, mental and dental care for Oregon Health Plan clients.

Starting in 2012, Oregon Health Plan clients have a new type of health plan called Coordinated Care Organizations or CCOs. A CCO is a network of all types of health care providers who are working together for people who receive health care coverage under the Oregon Health Plan. CCOs integrate physical, mental and eventually dental care for better health, better care and lower costs. CCOs focus on prevention of illness and disease and improving care to keep patients healthy and to manage existing health conditions.

The legal foundation for the OHP is generally spelled out in Chapter 414 of the Oregon Revised Statutes.[12]

Eligibility[edit]

Basic eligibility requires that the applicant be a resident of Oregon, as a citizen or otherwise. The level of coverage is based on income, age, mental and physical condition.

Coverage[edit]

Since a February 2003 adjustment to the Oregon Health Plan,[6] it consists of two main plans, OHP Plus and OHP Standard.

OHP Plus[edit]

OHP Plus is a full benefit package offered to children and adults who are eligible for Medicaid or for the Children's Health Insurance Program. The OHP Plus package has no premiums, but some adults may be required to pay small copayments for outpatient services and some prescription drugs.

In January 2010, most vision and some dental benefits were cut from OHP Plus due to budget deficits. In January 2011, John Kitzhaber again took office for a third term as governor, and has proposed new reforms and cuts to OHP Plus.

OHP Standard[edit]

OHP Standard is a limited benefit package covering a limited number of uninsured adults who are not eligible for Medicaid. In 2003, when OHP Standard began requiring small premiums of most adult participants, around 40,000 Oregonians (many homeless, destitute or mentally ill) were unable to pay the premium and were disenrolled from the program.[13] Significant cuts were made to the Oregon Health Plan's budget in 2003. Today, the monthly premiums are still required, but there are no copayments.[14]

Controversy[edit]

The Oregon Health Plan became the focus of national scrutiny in 2003, after deep budget cuts led to 100,000 people in mental health and/or substance abuse treatment losing prescription coverage under the program.[15]

During 2008 and 2009, the Oregon Health Plan stirred up controversy when enforcing 1994 guidelines[16] to only cover comfort care, and not to cover cancer treatment such as chemotherapy, surgery and radiotherapy for patients with less than a 5% chance of survival over five years.[17]

Springfield resident Barbara Wagner said her oncologist prescribed the chemotherapy drug Tarceva for her lung cancer, but that Oregon Health Plan officials sent her a letter declining coverage for the drug, and informing her that they will only pay for palliative care and physician-assisted suicide. She appealed the denial twice, but lost both times.[18] Tarceva drugmaker Genentech agreed to supply her the $4000-a-month[19] drug free of charge.[20] Wagner's plight garnered a flurry of attention from the media,[21] the blogosphere,[22][23][24][25] and triggered protest from religious groups.[26][27][28] Wagner died in October 2008, three weeks after starting Tarceva.[29]

Ongoing legislative efforts[edit]

Following the end of two terms as Governor of Oregon, Kitzhaber established the Archimedes Movement, which aims to be a grassroots effort toward crafting legislation and solving Oregon's health care problems. The Archimedes Movement also has a close relationship with the Foundation for Medical Excellence.[30][31]

The 2007 Oregon legislative session passed the Healthy Oregon Act (Senate Bill 329), which established the Oregon Health Fund Board.[32] This seven member advisory panel worked with former Governor Ted Kulongoski to propose legislation for the 2009 session. Among other challenges, the board has been advised that changes in federal requirements will affect funds that currently support 24,000 Oregonians on the OHP Standard plan.[33]

In June 2011, the Oregon Legislature with bi-partisan support created Medicaid (Oregon Health Plan) transformation with House Bill 3650. The goal of this legislation is to develop a health care delivery system managed by Coordinated Care Organization for Oregon Health Plan clients that are community-based, and have the flexibility to deliver better care, better health at lower costs. In March, 2012, Oregon Senate Bill 1580 was signed into law by Governor John Kitzhaber establishing Coordinated Care Organizations for Oregon Health Plan clients.

In August 2012, the first Coordinated Care Organizations opened to serve Oregon Health Plan clients.

See also[edit]

References[edit]

  1. ^ a b c d Lydgate, Chris. "In sickness and in health". Willamette Week 25 Years retrospective. 
  2. ^ Jacklet, Ben (August 5, 2005). "Activist’s ideals give rise to ideas". Portland Tribune. 
  3. ^ Korn, Peter (February 27, 2007). "Some forge ahead on reform". Portland Tribune. 
  4. ^ a b Pear, Robert (March 20, 1993). "U.S. Backs Oregon's Health Plan for Covering All Poor People". The New York Times. Retrieved 2008-07-14. 
  5. ^ Korn, Peter (February 27, 2007). "Elsewhere, there are saner ways to help mentally ill". Portland Tribune. 
  6. ^ a b Clark, Taylor (June 9, 2004). "Code Red". Willamette Week. 
  7. ^ "Thousands seek a spot on state health plan reservation list". Portland Tribune. February 4, 2008. 
  8. ^ Skidmore, Sarah (March 4, 2008). "Oregon Holds Health Insurance Lottery". Associated Press. 
  9. ^ "State Medicaid Program Adopts Multiple Policies to Significantly Increase Screening Rates and Enhance Access to Services for Young Children at Risk of Developmental Disabilities". Agency for Healthcare Research and Quality. 2013-09-11. Retrieved 2013-09-18. 
  10. ^ Steves, David (August 5, 2009). "Governor signs bill assuring kids health insurance". Eugene Register Guard. 
  11. ^ Kalinoski, Stacie (March 17, 2010). "Healthy Kids Boosts Numbers". KEZI. 
  12. ^ http://www.leg.state.or.us/ors/414.html
  13. ^ Steves, David (October 26, 2003). "40,000 Poor Lose Coverage". Eugene Register-Guard. 
  14. ^ "Oregon DHS". 
  15. ^ Egan, Timothy (March 3, 2003). "A Prescription Plan Lauded as a Model Is a Budget Casualty". The New York Times. 
  16. ^ "Statement of Intent for the Prioritized List of Health Services, page SI-1". .
  17. ^ Stevens, Jr., M.D., Kenneth R. (March 26, 2009). "Oregon Rationing Cancer Treatment but Offering Assisted Suicide to Cancer Patients: Paying to Die but not to Live". PCM Online. 
  18. ^ Harding, Susan (July 31, 2008). "Letter noting assisted suicide raises questions". KATU TV News. 
  19. ^ http://blogs.rep-am.com/worth_reading/?p=4326
  20. ^ Christie, Tim (June 3, 2008). "A Gift of Treatment – When the Oregon Health Plan fails to cover a cancer drug, the drug maker steps in". Eugene Register-Guard. 
  21. ^ Donaldson James, Susan (August 6, 2008). "Death Drugs Cause Uproar in Oregon". ABC News. 
  22. ^ http://wizbangblog.com/content/2009/08/04/oregon-health-plan-has-already-weighed-the-cost-of-life-1.php
  23. ^ http://thehappyhospitalist.blogspot.com/2009/08/it-looks-like-oregon-has-established-5.html
  24. ^ http://www.southernbellepolitics.com/2009/06/are-you-ready-to-die-soon.html
  25. ^ http://www.mofopolitics.com/2009/08/03/video-oregon-says-no-to-chemotherapy-offers-doctor-assisted-suicide/
  26. ^ http://www.catholicnewsagency.com/new.php?n=12857
  27. ^ http://www.lifenews.com/bio2608.html
  28. ^ http://www.lds.net/forums/current-events/24495-obamacare-met-barbara-wagner.html
  29. ^ Maynard, Steve (November 11, 2008). "Oregon Death with Dignity program spurs fierce debate, intense criticism". Tacoma News-Tribune. 
  30. ^ About Us | We Can Do Better - The Archimedes Movement
  31. ^ tfme.org - Home
  32. ^ Glascock, Stuart (March 10, 2008). "A Healthy Wager". Los Angeles Times. 
  33. ^ Kulongoski, Ted (2008-06-10). "Governor Kulongoski's letter to the OHFB" (PDF). Governor of Oregon.