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Thousands will lose Oregon Health Plan coverage

Retaliate against the state legislature. Don't vote for any incumbents in November.
Register-Guard
June 9, 2004
 link to www.registerguard.com


Thousands will lose health plan coverage

By Tim Christie

The steady erosion of the Oregon Health Plan continued Tuesday when state health officials said they will slash enrollment in the Standard benefit package over the next year.

The Standard plan covers low-income adults who don't qualify for traditional Medicaid. The state will stop enrolling new members on July 1, and cut the number of enrollees by more than half - from about 51,000 to around 25,000 - by June 30, 2005. As recently as January 2003, the plan had 110,000 members.

"It's one more nail in the coffin for low-income people who have almost nowhere else to turn," said Tim Miller of the Oregon Health Action Campaign, a patient advocacy group.

It's not known how many of the 5,408 Lane County residents on the Standard plan would lose their coverage.

When the Oregon Health Plan was enacted a decade ago, the brainchild of then-Sen. John Kitzhaber, it represented a bold new approach to health care of the needy and working poor. The idea was to ration health care and thus be able to serve more people.

By prioritizing services that would be covered and spending more state money on health care, Oregon was able to extend coverage to uninsured workers, childless adults, and others who had gone without medical coverage in the past.

But runaway medical costs, a long-lived state budget crunch and the the federal government's refusal to let the plan work as designed have forced state officials to drastically rewrite the plan and curtail the number people getting coverage.

"We've got to have a plan that's affordable and sustainable and that meets critical need," said Cindy Becker, deputy director of the Department of Human Services.

There was some positive news for OHP Tuesday: Starting June 19, OHP Standard enrollees no longer will have to make co-payments for drugs, doctor visits and hospital stays, after a federal judge ruled the payments violated federal law.

And some of the benefits that were cut from the Standard plan last year will be restored, albeit at lower levels. Those include prescription drugs, emergency dental treatment, outpatient mental health and drug and alcohol treatment, and a limited hospital benefit.

The Standard plan is one of two benefit packages in the Oregon Health Plan. The other package, known as OHP Plus, covers about 300,000 Oregonians, who are entitled to coverage under Medicaid. They include the disabled, blind, the elderly, children and pregnant woman.

The state will cut enrollments in the Standard plan by imposing stricter income eligibility requirements when members reapply every six months. Anyone with income equal to 100 percent of the federal poverty level - about $748 per month for a single person, $1,041 for a family of two - qualifies for OHP Standard. The state will change the eligibility requirement to somewhere between 30 percent and 50 percent of the federal poverty level.

The result, say state officials and patient advocates, is that more people will rely on emergency rooms when they get sick, which is the most expensive way to provide health care. And that will mean the cost will be shifted to people who have private health insurance.

"One way or another society pays," Miller said. "It's just a matter of how we're going to go about doing it."

The move to cut enrollment in the Standard plan came as no surprise to social service providers such as HIV Alliance.

"We knew it was coming, but it doesn't change how severe it will be for our clients," said Renee Yandel, client services director for the Eugene-based organization.

It's not clear yet which agency clients will be cut from the plan, Yandel said, "but whoever it is, it's the difference between life and death."

When people with HIV - the virus that causes AIDS - go without their medicine, the virus can mutate, which means they no longer can take that drug regimen. It also means their viral load will go up, and that means they're more likely to infect someone else, and more likely to develop AIDS.

"We'll have to stop looking at quality of life issues for clients and start looking at end of life issues for those people," she said.

The decision to cut enrollment in the Standard plan is the latest in a series of major changes to the Oregon Health Plan, resulting in part from voter rejection of tax-raising measures the last two years.

After the defeat of Measure 28 in January 2003, lawmakers cut benefits for the Standard population, including dental, mental health and substance abuse treatment. After the defeat of Measure 30 last February, lawmakers decided to use no state general-fund dollars to support the Standard benefit package.

But the 2003 Legislature did approve two new taxes - one on Medicaid managed care plans and one on hospitals - to help pay for the Standard plan, both of which required federal approval. Federal officials have approved the managed care tax and approval of the hospital tax is pending.

Each dollar from the new taxes will be matched with $1.50 in federal Medicaid money to help fund the Standard plan. But these revenues are not enough to pay for the plan at its current level, and the provider tax is only supposed to last for four years.

OUTREACH IS CRITICAL 09.Jun.2004 21:56

Melissa Mona mmona@lclac.org

The news coverage on this has given people the impression that the cuts are inevitable. This is not so. The Health Plan (OMAP) is estimating the number of people they can drop. How? By making it really difficult to comply. So, if you or anyone you know is on OHP-Standard, has been dropped for not paying premiums, or has any questions at all, call your local legal aid , or email me. I will try to help you figure it out. If you are not on the Health Plan, and think you might be eligible, you have to call the toll free enrollment number 1-800-359-9517 before June 30th and request that an application be mailed to you.

Bottom line is, the state HOPES they can screw 20,000+ people out of health care benefits, so let's make that harder for them to do. Please try to talk to neighbors, co-workers, people at the bus stop, etc. before time runs out. The state legislature and OMAP bureaucracy is counting on lack of information sharing and lack of community cooperation to pull this off. Let's show them how much we do care about each other. I am available by email, please contact me with any questions, I want to help.

A couple things to remember about OHP:

1. the state just lost a lawsuit on the issue of co-payments on OHP-Standard. By court order, after June 19th, OHP-Standard clients pay premiums, but no more co-payments (no more paying when you see the doctor or fill a prescription).

2. If you are enrolled in a federally recognized tribe, you are eligible for OHP-Standard, and can not be charged a monthly premium. You need to provide documentation to OHP. Again, if you have questions, contact Legal Aid or email me.

3. If you were disqualified for six months because you didn't pay your premiums, you need to know when the six month period ends. If it ends before June 30th, you can reapply, and you should do so. You need to pay past due premiums, too. If your six month disqualification ends after June 30th, you are not going to be able to get back on the health plan.

4. If you have a disability and can show that your disability was the reason that you could not pay your premiums on time, you can request "reasonable accommodation". This is most definitely something that your local Legal Aid should be able to help you figure out. If this is your situation, and your local Legal Aid can't help, please email me, and I will give you other ideas.

Useful links:

OHP  http://www.dhs.state.or.us/healthplan/app_benefits/ohpapply.html

Legal Aid (Oregon offices)  http://www.lanecountylegalservices.org/Offices.htm

541-485-1017 x134

OHP plans to lower FPL to around 0 10.Jun.2004 11:34

the antisocial social worker

In the past few months social workers and hospitals have been very sucessful with getting people enrolled onto the OHP standard prior to the end of enrollment June 30th. As a result it looks like OMAP is going looking at another direction for cutting the budget and screwing the poor out of insurance.

The plan (at this stage only a proposal) is to cut the income guidelines for the OHP from 100% FPL (about $787.00 per month federal poverty level) down to 30% Federal Poverty Level (or about $236.00 per month). Additionally it is possible they may eliminate hospital coverage (uninsured must legally be seen in ER but not in inpatient, from what I understand).

Clearly lobbying works, the sad part is not enough of do it to make a difference. So without further ado here are some more contact numbers. I recommend that we defeat any changes to the FPL requirements for the OHP standard.

Oregon Legislature
Legislative Committees . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . (503) 986-1813
House Democratic Office . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (503) 986-1900
House Republican Office . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (503) 986-1400
Senate Republican Office . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (503) 986-1950
Senate Democratic Office . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (503) 986-1700
Legislative Counsel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (503) 986-1243
Distribution Center (for copy of legislative bills) . . . . . . . . . . . . . . . . . . . . . . . . . (503) 986-1180
* receive one free copy of any bill
Web site Resources
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Oregon Legislature
www.leg.state.or.us

Poor Pride 10.Jun.2004 14:50

Lynn Porter

Thanks to the two commenters. I went to  http://www.leg.state.or.us/writelegsltr/writeset.htm and told my state senator and rep that I want them to do something about this, and if they don't I won't be voting for them in November.

I'm an OHP-Standard client. All of us who use the safety net, which we're entitled to, are slowly getting screwed as it gets cut. This has been going on for the last few decades, and it will keep on happening until we get organized and demand changes.

I don't know of any group in Oregon that is going out and organizing individual human services clients into a poltically active group. No one that I know of is sitting at tables in public places or going door-to-door to organize people.

We tried to start a group in Portland to fight human services cuts last year, Portland Survival, but it quickly fell apart. Not enough energy.

Oregonians for Health Security --  http://www.oregoniansforhealthsecurity.org/ -- does the most that I know of, but seems to lack outreach. You can sign up for their newsletter and email alerts on their website. Aside from that they don't seem to work with volunteers, never contacted me.

OHAC (Oregon Health Action Campaign) --  http://www.ohac.org/ -- does lobbying, seems to be mostly a coaltion of organizations. Individuals can join via their website, but they never contacted me after I did.

I've worked with Health Care For All - Oregon --  http://www.healthcareforalloregon.org/ -- in the past, but all they're interested in doing is a single-payer, universal health care initiative in 2006, which I don't think has any chance of passing. They are not interested in reforms or defending any of the present system.

In Portland MACG (Metropolitan Alliance for the Common Good) works on poverty issues, but it's a coalition of churches, unions, etc., and you can't join as an individual.

I know the Portland chapter of Jobs with Justice has organized at least one rally about health care issues, but I don't know if they have any ongoing campaign on human services issues. I think they're more focused on trying to help people who are working get better pay and benefits.

I think we need some kind of statewide organization of human services clients. Another option would be to try to organize poor people in general into a political block. I thought of "Low Income Voters" (LIV) or "Poor Pride". (If we can have a gay pride parade, why not poor pride? Another despised minority that needs to come out of the closet.) I could set up a discussion email list, but would be reluctant to do that unless a lot of people were interested. My experience is that it's hard to keep any kind of voluntary organization going. People have to be totally determined.

You can reach me by email at  lporter@efn.org