{"id":6972,"date":"2022-11-09T14:06:40","date_gmt":"2022-11-09T19:06:40","guid":{"rendered":"http:\/\/chirblog.org\/?p=6972"},"modified":"2022-11-09T14:11:37","modified_gmt":"2022-11-09T19:11:37","slug":"bridging-gap-oregons-proposal-ease-coverage-transitions-end-public-health-emergency","status":"publish","type":"post","link":"https:\/\/chirblog.org\/bridging-gap-oregons-proposal-ease-coverage-transitions-end-public-health-emergency\/","title":{"rendered":"Bridging the Gap: Oregon\u2019s Proposal to Ease Coverage Transitions at the End of Public Health Emergency"},"content":{"rendered":"

By Megan Houston, Rachel Schwab, and Rachel Swindle<\/em><\/p>\n

The continuous coverage<\/a> requirement that paused eligibility redeterminations for Medicaid enrollees will expire at the end of the federal COVID-19 public health emergency (PHE), which could take place as early as mid-January 2023. When redeterminations commence, approximately 8.2 million<\/a> Medicaid enrollees are projected to lose eligibility.<\/p>\n

To minimize coverage<\/a> and care<\/a> disruptions, many states have been preparing for this massive shift in coverage. Oregon is taking action to create a soft landing for these enrollees. Earlier this year, the state established a task force<\/a> to develop a plan to maintain coverage for the population transitioning off of Medicaid. In September, that task force published a report<\/a> with preliminary recommendations for creating a \u201cBridge Program\u201d by using Section 1331 of the Affordable Care Act (ACA), which authorizes state-based Basic Health Programs<\/a>\u00a0(BHP).<\/p>\n

<\/h3>\n

Background<\/strong><\/p>\n

Problems Posed by Churning Between Coverage Programs<\/em><\/p>\n

Most<\/a> Medicaid enrollees who lose eligibility at the end of the PHE will be eligible for other coverage, such as employer-sponsored insurance or ACA Marketplace plans, but transitions will not be seamless. Pre-pandemic, only 3 percent<\/a> of people losing Medicaid successfully enrolled in a Marketplace plan within 12 months. Coverage programs, like the Marketplace and Medicaid, often do not operate in coordination, especially in states that rely on the federally facilitated Marketplace. Different enrollment rules, procedures, and timelines can cause gaps in coverage, and differences between Medicaid managed care plans and commercial insurance can lead to disruptions<\/a> in needed care. During the COVID-19 PHE, continuous coverage in Medicaid was associated with<\/a> lower rates of delayed care and less trouble paying medical bills. The return of Medicaid redeterminations will mean more consumers will \u201cchurn\u201d in and out of Medicaid, placing gains in coverage and population health at risk.<\/p>\n

The Affordable Care Act\u2019s \u201cBasic Health Program\u201d<\/em><\/p>\n

Under the ACA, states have an option to provide coverage\u2014with the help of federal funding\u2014to lower income consumers that is closer in kind to Medicaid than traditional Marketplace plans. For individuals losing Medicaid, the BHP can provide a smoother transition to new coverage.<\/p>\n

The ACA\u2019s Marketplaces provide coverage options and premium and cost-sharing subsidies to individuals and families who do not otherwise have access to affordable health coverage. Section 1331 of the ACA enables states to establish an additional coverage option alongside the Marketplaces through a BHP. Under Section 1331, states can set up programs to cover individuals with household incomes between 138-200 percent of the federal poverty level (FPL) who are ineligible for other minimum essential coverage<\/a>, as well as non-citizens with lawfully present status with incomes up to 200 percent FPL who are ineligible for Medicaid due to their immigration status.<\/p>\n

Building on the BHP: Oregon\u2019s \u201cBridge Program\u201d Proposal<\/strong><\/p>\n

A Phased Approach to Churn Concerns<\/em><\/p>\n

Oregon\u2019s task force has recommended a phased implementation approach to the Bridge Program through a new state BHP:<\/p>\n