Initial Medicaid Implementation: Oregon implemented their Medicaid program in July of 1967.When the state began their Medicaid program the state did not offer benefits for the medically indigent. The Medicaid program was run under the Department of Human Resources’ Adult and Family Services Division until 1990. The Medical Consultant was first established in 1933 as part of the State Relief Commission. The duties were later transferred to the title of Administrator and control of regulation of hospitals and care for children with medical needs were added. The office was moved to be under the jurisdiction of the governor in 1971.
Key Medicaid Political Issues: Oregon has consistently been a leader in addressing coverage and expanding coverage prior to federal action. The movements began in 1987 under the leadership of then state Senator and future Governor John Kitzhaber. The legislature passed a series of laws known as the Oregon Health Plan. The plan extended coverage for people under the poverty level, instituted an employer mandate, create an insurance pool for people with pre-existing conditions, created a small business marketplace, regulated medical technology, add new programs for people with disabilities, and extend mental health coverage. In 1994 the state received the funding and approval to expanded Medicaid to all residents living below the poverty level enrolling 120,000 newly insured residents. The following year the state added mental health and substance use treatment services to the plan. The state also implemented a board to oversee drug utilization. The state’s reforms were extended through 2002 following a successful implementation. Some of these services were repealed in 2003 following economic constraints in the state. The state faced a number of constraints that led to enrollees being required to pay a premium to receive Medicaid services, Oregon implemented a waiver in 2008 that expanded Medicaid coverage to low-income childless residents in the Portland area that would have not otherwise been eligible for Medicaid coverage. There has been extensive research into the effects of this Medicaid expansion on the health of the population. Most notably it was found that newly insured were more likely to use the emergency room than people who did not gain Medicaid coverage and remained uninsured. The state has worked to improve care coordination and redirect people away from the emergency room. In 2012 the state began using Coordinated Care Organizations (CCOs) to improve the delivery of care by providing mental health, dental care, and other community based services and reimburse based on performance.
Medicaid Expansion Implementation: Oregon was one of a handful of states to implement policies to allow people to enroll in coverage more quickly if they were already proven to be eligible for another state run program. In January 23 of 2018 an initiative was brought before Oregon voters on how to fund the Medicaid expansion and where the tax revenue for the expansion would come from. The initiative was approved by the public. In 2017 the state moved to cover undocumented children in their Medicaid program. In 2016 the state added long-acting birth control as part of the covered benefits for the Medicaid expansion population.
General facts about Oregon Medicaid:
Medicaid program name: Oregon Health Plan
CHIP Program name: Healthy Kids
Separate or combined CHIP: Separate
Medicaid Enrollment: 962,000 (2018 estimate)
Total Medicaid Spending: $8.4 billion (FY 2017 estimate)
Share of total population covered by Medicaid: 24%
Share of Children covered by Medicaid: 50% (estimate)
Share of Medicaid that is Children and Adults: 83%
Share of Spending on Elderly and people with disabilities: 41%
Share of Nursing Facility Residents covered by Medicaid: 57% (estimate)
Expansion state: Yes
Number of people in expansion: 557,000 (2018 estimate)
Work Requirement: No