Oregon Health Plan changes improve access to care

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Access to health care through Oregon Health Plan (OHP/Medicaid) continues to grow and improve through a number of changes to OHP policy. Some of these changes took effect in 2023, and others take effect this month or later in 2024.

OHP benefits that took effect in 2023 that you may not know about

• Expanded benefits for children. OHP now covers all medically necessary and medically appropriate care for members under 21. This includes services that OHP didn’t cover before, such as certain specialty care and durable medical equipment, as well as other less common treatments. Now, if your health care provider determines a treatment, procedure or medication is medically necessary and appropriate for a member under 21, OHP fully covers it. If your provider says “OHP won’t cover that,” ask for the denial in writing and contact your coordinated care organization (CCO) or OHP Client Services at 800-273-0557. These expanded benefits took effect Jan. 1, 2023. Learn more about them here.
  
  
• Full OHP coverage available regardless of immigration status. Eligible people of all ages, regardless of immigration status, have access to full OHP Plus benefits if they meet income requirements. OHP Plus coverage includes medical, dental and mental health care; prescriptions and tests; X-rays and hospital care; rides to and from health care appointments. This policy took effect July 1. Learn more on our blog.
  
  
• Transportation reimbursement rate increase. When members drive themselves to doctors’ appointments or other covered health care services, or are driven by someone else such as a friend or relative, they can be reimbursed at a rate of $0.44 per mile—a 76% increase over the previous rate. To request approval for reimbursements and learn more about this option, call your CCO or local ride service. Reimbursement rates also increased for lodging and meals if members have to travel out of their local area for care. These increases took effect in April 2023.

OHP benefits that take effect in January 2024

• Continuous eligibility protections. Oregon’s new policy called “continuous eligibility” means most people will keep coverage until their next renewal–even if their income or family size changes before then. This applies to most cases that have renewed or applied for OHP since April 2023. During the pandemic emergency, people kept OHP even if they were no longer eligible. The new continuous eligibility protections apply only after someone’s post-pandemic renewal (which started in April 2023). People who have renewed since then may see a “continuous eligibility period” in their eligibility notice.
  
  Exceptions:
  
  • Continuous eligibility does not apply to most long term services and supports.
  • Protections begin only after completion of the application or renewal process, including resolving any requests for information.
  • Benefits can still close or be suspended if you move out of state, voluntarily ask us to close benefits, become a resident of a public institution such as jail, prison or the state hospital, pass away, or in cases of fraud or error. Help paying for Medicare may end if you lose Medicare.
    
    Learn more about continuous eligibility here.

• Faster enrollment in a coordinated care organization (CCO). Most new OHP members will be enrolled in a CCO within a few days after selecting one. Previously, newly enrolled members often spent a week or more on OHP’s “Open Card” coverage while they waited to be transitioned to a CCO. Open Card coverage provides the same care benefits as regular OHP, but there are fewer (and often different) providers who accept Open Card. By transitioning into a CCO within a few days of starting OHP coverage, it will be easier for new members to find a doctor and reduce disruptions in care. If members do not choose a CCO, most will be assigned one, and the transition may take longer.

OHP benefits that will take effect later this year

• Higher income limits with OHP Bridge. This is a new health coverage program launching in July 2024. OHP Bridge will cover adults up to age 65 with income above traditional OHP Plus limits up to 200% of the federal poverty level (FPL) who do not have access to affordable health insurance. For example, a single adult making up to $29,160 per year may qualify for OHP Bridge, which is a significant increase over previous OHP Plus income limits. Adults must also have eligible citizenship or immigration status to qualify.
  
  OHP Bridge members will have access to quality medical, dental and behavioral health care, as well as transportation to medical appointments and health service, with no member costs such as premiums, copayments or deductibles. OHP Bridge will allow current OHP members to stay in their CCO so they can keep their doctors. However, OHP Bridge will not cover long term services and supports, and those covered by Medicare or who are offered employer coverage will not be eligible for OHP Bridge.
  
  OHP Bridge will begin accepting applications July 1. During renewals, OHP members likely to be eligible for OHP Bridge will keep coverage until the new program starts. More information will be available in the coming months.