Oregon’s Groundbreaking Medicaid Waiver Sets New Bar for Equity
By Suzanne Wikle
Oregon recently received approval from the Center for Medicare and Medicaid Services (CMS) to implement changes to its Medicaid program. Notably, the state will now provide continuous coverage for eligible children under age 6 and 24 months of continuous coverage for eligible Oregonians who are 6 and older.
What does continuous coverage mean for people insured by Medicaid? It means that increases in income—from picking up a few extra shifts or getting a small raise—won’t jeopardize their health insurance. It means parents of young children on Medicaid can be confident their children will have health insurance for years. It means fewer people will incur medical debt, a significant driver of bankruptcies.
All of this allows people to focus their energy on things other than Medicaid paperwork – their families, their jobs, their education.
Oregon’s groundbreaking Medicaid waiver is big news in the health policy space because the provisions will certainly lead to greater health outcomes and help ensure young children have consistent access to developmental screens and check-ups.
But Oregon’s plan is also groundbreaking from an anti-poverty and racial equity standpoint. Because of racism and systemic barriers around education and employment, people of color are more likely to have low incomes and be eligible for Medicaid. So, the administrative burdens associated with applying for Medicaid, keeping it if you have small changes in income, and renewing it every year fall disproportionately on people of color. When people can’t navigate these barriers, they lose their health insurance, even if they are still eligible. And, even if they can re-enroll, the lapse in coverage can harm their health. The mental load of stressing about losing coverage and completing the paperwork process is taxing.
With the continuous coverage provisions, Oregon has effectively eliminated a significant part of the red tape typical in Medicaid programs because people won’t have to navigate the renewal process and its paperwork as frequently. Reducing administrative burden, or the bureaucracy associated with Medicaid and other benefit programs, is an important step toward making access to health insurance more equitable. Continuous coverage policies are one of the best ways to do that. Oregon’s approach of ensuring up to six years of continuous coverage for the youngest children, and two years for every person age six and older, is above and beyond what any other state is doing.
CMS also permitted Oregon to receive federal Medicaid matching funds to support certain ”health-related social needs” for individuals experiencing life transitions. This provision addresses the fact that a person’s health is directly linked to such social needs as housing and food. Oregon will be able to receive some federal Medicaid matching dollars to help certain populations – particularly experiencing transitions in their lives (at risk of homelessness, youth transitioning out of the child welfare system, etc.) — meet these fundamental needs to help them maintain their health.
Oregon’s forward-thinking approach, and CMS’s approval to test these approaches, will lead to important lessons for other states. This is especially true regarding the support of health-related social needs. We know that the continuous eligibility provisions Oregon is planning will reduce churn. The state’s changes will also alleviate administrative burdens and the mental toll they take on people. Other states should consider similar waivers.