OHA: Determining Medicaid eligibility complicated

Oregon is the first state to allow continuous coverage for children until age 6, without requiring annual reapplications, under the Oregon Health Plan.

It is one of the features of a five-year Medicaid waiver just approved by the Centers for Medicare and Medicaid Services, which oversees the joint federal-state program for health insurance coverage for 1.4 million Oregonians.

The waiver takes effect Saturday, Oct. 1.

According to August data from the Oregon Health Authority, a total of 145,584 children under age 6 were covered by 17 coordinated-care organizations that provide services under the Oregon Health Plan. About 100,000 were ages 2-6.

For Oregon Health Plan recipients age 6 and older, the waiver will ensure continuous coverage for two years for physical, dental and behavioral health care. It also will open the way to health-related coverage for some social needs, such as food assistance and housing support, and some support for climate-related health needs.

Oregon is projected to gain an additional $1.1 billion in federal money over five years.

Gov. Kate Brown made the announcement jointly with federal officials.

Her statement:

"With the approval of our Medicaid waiver, we will be taking an innovative, holistic approach to closing equity gaps by addressing health-related social needs — such as housing, nutrition, and support for extreme climate events.

"This transformational agreement injects new resources into our health care system to help Oregon families and communities tackle the housing and food insecurity problems that can undermine good health and quality of life. I appreciate the Biden-Harris administration's partnership and their support to allow Oregon to once again break new ground in advancing the health and well-being of people in our state."

In a pair of tweets following the announcement, U.S. Sen. Ron Wyden had this to say. The Oregon Democrat leads the Senate Finance Committee, which oversees Medicaid and other major federal health insurance programs.

"Glad that @CMSGov has granted Oregon's request to become the first state to provide continuous coverage under Medicaid for children from birth through age 5. This is a huge step in keeping our communities healthier and safer.

"I'll continue working to ensure kids across the country have this same expanded coverage so they have every opportunity to thrive."

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