----- Original Message -----
From: Loriann Sheridan
Sent: Thursday, September 11, 2003
Subject: Request/Opportunity for Public Input to the New Oregon Health Plan
To Expanded Access Coalition participants,
The Legislative session required our efforts to keep the need for the Oregon
Health Plan and the impact of its erosion visible.
The Legislature made its decisions. Now the rules and more detailed policies
which will help shape both the revised Medically Needy program (now called
Medical Expansion for Persons with Disablities and Seniors -- MEDS) and the new hospital benefit for OHP Standard are being developed.
We applaud OMAP / DHS outreach to all who care and are interested as the
State attempts to design as consumer friendly a program as possible within
constraints handed them by the budget and the letter of the law.
Below please find request for input to the policies for the new MEDS
program. A meeting for further discussion will likely be set. For more information, contact Sandy Wood at Sandy.A.Wood@state.or.us or 503-945-6530. Your comments on the attached will set the framework for any fuure discussion.
In addition, the DHS website posted the following information about a meeting
to determine the components of the new, limited hospital benefit.
Finally, last but not least, the Expanded Access Coalition will be meeting on
Tuesday September 23rd from 9:30 to 11:30 at the OHAC office (3896 Beverly Avenue NE, J-6, Salem) to focus on the premium issue, outreach to uninsured children, enrollment numbers, FHIAP and the evolving benefits packages for OHP Standard and some subset of those who were formally
enrolled in the Medically Needy program.
More information about our September 23rd EAC meeting will follow shortly.
Please mark your calanders.
Ellen Pinney * Oregon Health Action Campaign
503-581-6830 (Salem office) * 503-695-2806 (Portland home office & fax)
503-380-3288 (cell) * 503-370-7630 (office fax)
In a message dated 9/9/03 11:44:50 AM, Sandy.A.Wood@state.or.us writes:
<< The Department of Human Services (DHS) wants your help in setting policy
for a new program. The Legislature with HB 2511 gave us authority to implement a new program for low income seniors and persons with disabilities, which we're
calling the Medical Expansion for persons with Disabilities and Seniors (MEDS)
program. This program is the result of a combined effort by both houses of
the Legislature to address some of the needs of the former Medically Needy
clients within the budget constraints of our current economy. The Legislature
allocated $18 million for the 18 months left in this biennium, assuming a
January 1, 2004 implementation.
DHS included this program in a waiver amendment request to the Centers for
Medicare and Medicaid Services (CMS) that we mailed on September 5, 2003.
This means we're asking for permission to include this new program in our OHP
demonstration project and obtain matching federal funds.
Attached is a summary of the program. DHS wants your input on policy
decisions left for us to make by the bill. It's likely that CMS will want
specific answers within about two weeks, so we have little time to make these
decisions. Given that, I'd appreciate your responses by September 18, 2003.
Here are the policy decision that are still on the table:
1. The bill requires cost sharing in Section 11 (2) by saying, "A person
receiving prescription drug services under Section 4 (1)(b) of this 2003 Act
shall pay up to a percentage of the Medicaid price of the prescription drug
established by the department by rule and the dispensing fee." What
percentage of cost sharing should we establish * one that allows us to cover
the most vulnerable in the population while letting as many people in the
program as we can. The verbal legislative record indicates most legislators
mentioned 30% - 50% as appropriate.
2. The bill states that DHS will establish a gross annual income standard.
Standards are usually set as a percentage of the federal poverty level (FPL),
which is around $800 per month. The verbal record of legislative intent
indicates most legislators mentioned 133% of the FPL as appropriate. This
equates to around $1,065 per month.
3. There's a possibility of an out of pocket maximum for enrollees. We're
pricing it at $200 - $500 per month. The program will serve more people with
a higher out of pocket maximum and less people with a lower limit. Should we
establish an out of pocket maximum and what's appropriate?
4. Given that we'll need to cap enrollment, should we include an assets test
so people with large liquid assets will not get assistance over those with
limited assets? Should it match OHP and OSIP ($2,000) or CHIP and FHIAP
5. Should we tailor enrollment so certain needy clients get in the door
first, such as: First, the "grandfathered" clients with HIV/AIDS and organ
transplants; second, the most vulnerable of the former Medically Needy
population; and third, the rest of the former Medically Needy population?
Some policy decisions already are made for us, either by the bill itself, the
amount of funding, or in committee: These include:
1. The program has to stay within the $18 million budget.
2. It has to be administratively simple so more money can be spent on
2. No spend downs.
4. We need to begin with prescription drugs, and the legislature can add
mental health and chemical dependency if funds allow.
5. The legislature expects DHS to cap the program to stay within budget.
We'll look at enrollment and utilization over time and make adjustments
accordingly to stay within budget.
Thanks you so much for giving us your recommendations for the new MEDS
program, so we can make decisions to best serve this vulnerable population.
503-581-6830 ext. 13 (office)
"Never doubt that a small group of committed citizens can change the world. Indeed, it's the only thing that has." - Margaret Mead