After two years of planning, Oregon is officially expanding Medicaid to give tens of thousands more people access to free health insurance.
The Oregon Health Authority announced Monday the launch of the OHP Bridge Plan for those whose income exceeds federal limits for the traditional Medicaid program. Oregon Health Plan, the state's version of Medicaid, currently covers 1.4 million Oregonians who earn up to 138 percent of the federal poverty level, or nearly $21,000 a year for a single person or more than $43,000 a year for a family of four.
The OHP Bridge expands Medicaid benefits to those earning up to 200% of the federal poverty level. That means people earning about $30,000 a year or families of four earning $62,400 a year will qualify for the program.
Oregon Health Authority officials expect the plan to cover 100,000 Oregonians by 2027.
Dr. Sejal Hathi, director of the Health Care Authority, said at a press conference that the plan is a "major milestone" in Oregon and will help eliminate health disparities, which is one of the Health Care Authority's goals.
"We know that higher rates of coverage are associated with better health outcomes, better access to care, and less health disparities, and we want to keep it that way," Hathi said.
Who is entitled to
You can apply for the OHP Bridge program at ONE.Oregon.gov or HealthCare.gov. Oregon residents may qualify for the OHP Bridge program if they:
- Between the ages of 19 and 64
- Have income between 138% and 200% of the federal poverty level
- Are a U.S. citizen or have appropriate immigration status
- Do not have access to other affordable health insurance
Income limits change every March. More information can be found here: https://ohp.oregon.gov/Bridge .
Oregon has become the third state in the nation - after Minnesota and New York - to expand Medicaid to a level that exceeds traditional federal income limits. But it is the first state to offer this coverage for free, with no monthly premiums or co-payments.
"We know that cost-sharing in any form, whether it's premiums or co-payments, is a barrier to health care for people at this income level, and if we were to impose one or both of those conditions, we would see a reduction in access to care, which is contrary to the state's goals," said state Sen. Elizabeth Steiner, a physician and one of the legislators who developed the bridge plan.
Like Medicaid participants, people eligible for a Bridge plan will have free medical, dental and mental health care, as well as certain other benefits, such as transportation to medical appointments.
"This means more people will be able to get the diagnoses, treatments and other services they need, avoiding delays in care and treatment that nearly 300,000 Oregonians would otherwise have to pay for," Haty said.
Gil Munoz, executive director of Virginia Garcia Memorial Medical Center, which serves many Medicaid patients in Forest Grove, said at a news conference that the plan is a win for working families who struggle to pay for housing, food, transportation and child care. It's also a boon for providers who work with low-income families to get them the diagnostic services, specialist care and hospital treatment they need, he said.
"It eases the path to better health and prevention for these families," Muñoz says.
Federal Approval
Oregon has received permission from the federal Centers for Medicare and Medicaid Services to offer a plan under the Medicaid waiver program. This authorization means that the federal government will pay most of the cost of the plan by redirecting money it would normally pay in subsidies to people who would otherwise buy health insurance on the federal marketplace. The state will pay the remaining cost.
In the traditional Medicaid program, the federal government picks up about 60 percent of the costs and Oregon pays the rest. Payments under the Bridge plan would be handled differently: the federal government would transfer the money into an account and the state would then count it. Erica Heartquist, a spokeswoman for the health department, said the state estimates Oregon will receive about $500 million in federal revenue over the next 12 months to pay an average of 65,000 plan members a month. The state will likely spend $10 million to administer the program and cover costs not paid for with federal funds.
Health officials argue that insuring people ends up costing less in the long run because they address major problems early or even before they occur by seeing a primary care doctor regularly and getting preventive care, such as cancer screenings and blood tests to determine their cholesterol levels and risk of developing diabetes. Those without insurance often wait until a health problem worsens, until they become seriously ill and treatment becomes more expensive, or go to the emergency room, which is the most expensive type of treatment and increases overall health care costs.
"The basic health care plan, OHP Bridge, is a value proposition for Oregon taxpayers," Hathi said.
The plan has been in development in Oregon for two years, following the passage of Bill 4035 during the 2022 session, which created a task force to develop the plan. One of the main goals of the plan is to cover people who have recently lost their Medicaid insurance. During the pandemic, the federal government gave extra benefits to states that kept people enrolled in the program regardless of income changes. This meant that even when people's income changed and they technically no longer met the limit, they continued to have free insurance.
But that changed last spring when the federal government ended the program. Since then, state officials have checked Medicaid enrollment rolls to make sure everyone is eligible. In Oregon, more than 80 percent of program participants have kept their insurance - one of the highest rates in the country, according to a KFF Health News analysis.
About 222,000 people have dropped out, and state officials have directed them to the federal marketplace to buy individual insurance. Hathi said up to 30,000 people who remained in the Medicaid program during the pandemic but are no longer eligible will be moved to a bridge plan Monday because they meet the bridge plan's income limits.
While they will enjoy most Medicaid benefits, those in the Bridge plan will not be eligible for long-term care and will not be able to receive social services that have been approved under CMS's Medicaid Patient Improvement Agreement. Under this agreement, Oregon can offer patients climate support, such as a free air conditioner or air filter to help them cope with extreme weather events and smoke from wildfires; housing support for up to six months; and nutrition education and food assistance.
Officials enacted a climate benefit this spring, although fewer patients than anticipated received air conditioners. The housing benefit is expected to be in place by the end of the year and the food benefit afterward.