{"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 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 The task force has emphasized that the Bridge Program will mitigate the coverage \u201ccliff\u201d that consumers face when they lose Medicaid, when the public health emergency ends and beyond. While some stakeholders have endorsed<\/a> Oregon\u2019s proposed plan, others have shared concerns; the state hospital association<\/a>, likely fearful of losing the higher reimbursements they receive for commercially insured patients, argued that any Bridge program should be temporary, and that the state should aim over the long term to transition those losing Medicaid into Marketplace or commercial insurance. An insurer<\/a> that primarily serves the private market expressed concern that a BHP would cause \u201cmarket destabilization.\u201d<\/p>\n Reducing Care Disruptions and Implementation Barriers Through Existing Medicaid Infrastructure<\/em><\/p>\n Oregon\u2019s new BHP would largely leverage the infrastructure of its existing Medicaid program. Oregon\u2019s Medicaid enrollees receive benefits through \u201ccoordinated care organizations\u201d (CCOs), a type of<\/a> Medicaid managed care organization (MCO) operating under a global budget. The recommended Bridge Program would offer coverage through CCOs. The \u201cideal scenario\u201d outlined in the report would allow most current Medicaid enrollees to \u201ctransition[] in place,\u201d rather than enroll through a different state program like the Marketplace. CCOs\u2019 existing relationships with providers may allow<\/a> BHP enrollees to access similar provider networks at significantly less cost-sharing than they would face in many Marketplace plans.<\/p>\n Program Details Shaped by Federal Funding Parameters<\/em><\/p>\n By creating a BHP, Oregon can draw down federal funding to finance its Bridge Program. In general, the federal government pays states that operate BHPs on a per-person basis equal to 95 percent of what enrollees would have received in federal subsidies had they enrolled in exchange coverage. These funding parameters influenced Oregon\u2019s BHP design to ensure manageable state program costs.<\/p>\n Provider reimbursement rates<\/u>: Provider reimbursement rates significantly influence the cost of the BHP, and provider groups have played an active role in Oregon\u2019s evaluation and consideration of a BHP, consistently noting a strong preference<\/a> for payment rates that are higher than what they receive for Medicaid patients. Ultimately, the task force recommended the program establish baseline rates that allow CCOs to pay providers more than they do under the state\u2019s Medicaid program but less than they receive from commercial insurers. However, CCOs operate through \u201cglobal budgets\u201d and exact rates would not be state-determined.<\/p>\n Generosity of coverage<\/u>: The generosity of the BHP benefits package also impacts the cost of a BHP. While BHPs must cover at least the ten E<\/a>ssential <\/a>H<\/a>ealth <\/a>B<\/a>enefits<\/a>, states have some flexibility to establish benefit and cost-sharing designs. Oregon\u2019s task force recommends that the Bridge program aligns its benefits with the state\u2019s Medicaid benefits, including coverage of adult dental care. The task force further recommends that cost-sharing be a \u201clast resort,\u201d only used if necessary for program sustainability and based on a sliding scale according to enrollee income.<\/p>\n Takeaway<\/strong><\/p>\n The BHP is one of several state policies that can increase and improve health insurance coverage. Alongside the federal expansion<\/a> of premium subsidies under the American Rescue Plan Act (recently extended<\/a> by the Inflation Reduction Act), states have implemented and explored public options<\/a>, state-funded financial assistance<\/a>, Medicaid innovation waivers<\/a>, and other policies to expand access to affordable, comprehensive health insurance. The BHP allows states to leverage federal funding to offer affordable and comprehensive coverage to lower income residents, but like all of these policies, the feasibility and effectiveness of a BHP depends in large part on local market conditions and existing infrastructure.<\/p>\n Under the task force\u2019s recommended path to a BHP, Oregon\u2019s program would take years to implement, and require the state to build a new state-based Marketplace<\/a> eligibility and enrollment platform. Future legislative reports will explore the effect of the program on the larger market and recommend strategies to mitigate potential disruptions.<\/p>\n The end of the COVID-19 PHE will undoubtedly test our coverage safety net programs as millions of people lose Medicaid eligibility. If the state legislature acts to implement the task force\u2019s recommendations, Oregon\u2019s Bridge Program may provide a pathway to coverage that reduces enrollment barriers and care disruption to protect recent coverage gains<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":" At the end of the COVID-19 public health emergency, millions of people will lose Medicaid as states resume eligibility determinations. To help connect these consumers to a new source of affordable coverage, Oregon is considering an option under the ACA to leverage federal funding for health plans that cover lower-income consumers: a Basic Health Program (BHP). CHIR took a look at a recent state task force report recommending a BHP in Oregon to serve as a \u201cbridge program.\u201d<\/p>\n","protected":false},"author":5,"featured_media":4010,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8,478,1],"tags":[],"_links":{"self":[{"href":"https:\/\/chirblog.org\/wp-json\/wp\/v2\/posts\/6972"}],"collection":[{"href":"https:\/\/chirblog.org\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/chirblog.org\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/chirblog.org\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/chirblog.org\/wp-json\/wp\/v2\/comments?post=6972"}],"version-history":[{"count":5,"href":"https:\/\/chirblog.org\/wp-json\/wp\/v2\/posts\/6972\/revisions"}],"predecessor-version":[{"id":6977,"href":"https:\/\/chirblog.org\/wp-json\/wp\/v2\/posts\/6972\/revisions\/6977"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/chirblog.org\/wp-json\/wp\/v2\/media\/4010"}],"wp:attachment":[{"href":"https:\/\/chirblog.org\/wp-json\/wp\/v2\/media?parent=6972"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/chirblog.org\/wp-json\/wp\/v2\/categories?post=6972"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/chirblog.org\/wp-json\/wp\/v2\/tags?post=6972"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}<\/h3>\n
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