Oregon is the first state in the country that will allow children with Medicaid coverage to remain continuously enrolled until their sixth birthday.
This means that low-income families will not have to re-enroll each year to keep their children insured.
Governor Kate Brown made the announcement Wednesday morning, along with federal officials from the Centers for Medicare and Medicaid Services.
“Keeping young people consistently enrolled in Medicaid until age 6, to prevent gaps in coverage, regardless of changes in their financial circumstances is a paradigm shift,” Brown said.
More than one in three children in Oregon is covered by the Oregon Health Plan.
In another change, Oregon and Massachusetts will become the first two states to use the federal health insurance program to fund rent assistance and food aid for certain eligible state health plan enrollees.
In Oregon’s case, the state will receive a significant boost in new federal funding for housing and food assistance: $1.1 billion over the five years that the program is in effect. Oregon will be required to contribute $88 million in government funding in the final year of the program.
Oregon’s new Medicaid spending on so-called “health-related social needs” will also include a program targeting the health impacts of climate emergencies.
Oregon health plan enrollees with a proven medical need can qualify for a benefit that directly covers the cost of things like air conditioners, air filters, or temporary shelter during a wildfire or other declared emergency.
Oregon HealthPlan has applied for and received changes through a five-year waiver process.
The federal government allows states to use waivers to bend the model rules that govern Medicaid. Exemptions encourage innovation and are meant to be cost-neutral.
Kids stay safe
Joanne Alker, with the Georgetown University Health Policy Institute, a nonpartisan think tank, has long advocated for continued coverage of children.
“In the United States, when you’re 65, everyone knows you’re going to get Medicare. It’s not true when you have a child,” she said. “I think the Oregon approach brings us one day closer to a day when that vision comes true, a day when a child doesn’t leave the hospital. Without health insurance.”
Nationwide, between 5 and 6 percent of children do not have health insurance. Experts say the annual re-enrollment process is a major reason for this gap in child coverage. Some families may never get the required paperwork in the mail or struggle to complete them, especially if they are on the move frequently or have limited English proficiency.
Eliminating gaps in child coverage also provides better economic security for families, Elkair said.
“Even getting a big medical bill — a kid falling on the playground, breaking a bone, having to go to the emergency room — can be a massive medical debt,” Alker said.
Washington, New Mexico and California are considering similar proposals to make children eligible for more ongoing Medicaid coverage.
In Oregon, the shift toward more continuous enrollment is not limited to young children. Children 6 years of age and older and Medicaid adults will be able to stay enrolled for two years at a time.
Medicaid eligibility checks have been suspended during the COVID-19 pandemic, but will resume when the federal government’s declaration of emergency expires – a date that has yet to be announced.
It is then that Oregon’s new enrollment policies are expected to begin.
The policies will reduce the number of people starting Medicaid and add to the number of enrollees, increasing program costs. The cost over the next five years, according to the Oregon Health Authority, will be $850 million in federal dollars and $409 million in US dollars.
Eclair says investing in health care for young children pays off for communities in the very long run.
Using healthcare dollars to pay for housing and food
Not all those enrolled in an Oregon health plan will be eligible for housing and food assistance. The program is designed to support the health of Medicaid enrollees in “transition,” a group that includes young people in foster care, people who are homeless or at risk of homelessness, and low-income seniors, according to the OHA.
Rental assistance through Medicaid will be available for up to six months. Other services can last longer.
Mercedes Elisalde is Director of Policy at Central City Concern, a social services and health care organization that serves homeless people and those treated for substance use disorders.
Currently, she says, some Central City Concern clients who are being treated for substance use disorder have no access to housing assistance — a situation that makes them more likely to not complete treatment.
“This announcement today is the first step to putting this kind of inhumane incompetence in the rearview mirror,” she said.
The program will also fund food aid for “transition” groups, including food boxes and prescriptions for vegetables and fruits.
Enrollment for the new food and housing benefits will begin in 2024, according to the OHA.