Oregon in top four states protecting medical benefits
SALEM, Ore. – More than halfway into the unwinding of federal pandemic benefits, renewal data shows that more than 8 out of 10 Oregonians are keeping their Oregon Health Plan (OHP) or other Medicaid benefits. So far, around 1 in 6 people’s benefits are ending or reducing. Updated renewal categories now allow Oregon to compare benefit closure and reduction rates across states. So far, Oregon has the fourth-lowest closure and reduction rates in the nation.
OHP renewals after the pandemic
During the COVID-19 pandemic, the federal government allowed states to keep people on Medicaid and did not require annual eligibility renewals. This ended when the public health emergency ended, and Oregon is currently making sure everyone on OHP is still eligible.
Everyone who has OHP or other Medicaid-funded services and supports will receive a renewal notice by mid-2024. The notice will explain whether the member needs to provide additional information or take action to keep their coverage.
Oregon can process many renewals automatically. Some members need to provide additional information so that we can determine if they are still eligible. Additional information requested from members may include documents such as paystubs or a renewal packet they are asked to review, sign and return.
OHP renewals so far
As of Oct. 19, 2023, 807,765 people have completed the renewal process. This represents 55.6 percent of all OHP and Medicaid members, taking Oregon more than halfway through the unwinding process.
- 668,265 people (82.5%) were renewed and kept their benefits.
- 111,998 people (13.8%) were found ineligible. Closures began at the end of June.
- 25,714 people (3.2%) had a reduction in their benefits. Most of these members lost full OHP, but were able to continue our Medicare Savings Programs that help pay their Medicare costs.
October OHP renewal requests
In October, renewal letters were sent to an additional 137,032 people.
- 65.4 percent were renewed without any action needed.
- 19.4 percent were asked to provide some information to renew. The most common requests are for income-related proof, like paystubs, or forms of identification, like a government identification or birth certificate.
- 11.9 percent were asked to fill out a renewal form.
- 3.4 percent had previously reported that they no longer met income limits or other requirements, so received a notice that their benefits will be ending in 60 days.
Data dashboard update
Oregon Department of Human Services (ODHS) has recategorized some renewals in the Medical Redeterminations Dashboard. People who were automatically renewed but still need to submit some information were previously categorized as completed renewals with continuing benefits. These renewals now appear as initiated renewals awaiting member response. With this change, renewal data can now focus on completed renewals.
This allows for state-by-state comparison; Oregon’s 17% closure and reduction rate is currently the fourth lowest in the nation .
State responds to renewal system issues
This month, Oregon Health Authority (OHA) and ODHS responded to three issues with the renewal process:
- Extending coverage for members who received incorrect approval notices: Around 11,700 members who did not respond to renewal requests received incorrect approval notices instead of closure notices. ODHS/OHA extended their coverage extended through the end of the year. These members received a new notice and call explaining that they can provide the missing information by the end of the year to prevent closure.
- Correcting or preventing incorrect terminations: Medical benefits for 2,268 people incorrectly ended at the end of September. 1,226 people incorrectly received notices explaining that their benefits would end at the end of October. ODHS/OHA will restore these people’s benefits or prevent them from closing. All affected members will receive new notices in November. In 2024, they will get another notice letting them know whose benefits are renewed without needing a response, and who in their household still needs to respond to a renewal to keep benefits.
- Restoring Oregon Supplemental Income Program—Medical (OSIP-M) benefits: OSIP-M is a program that provides OHP coverage to Oregonians who are legally blind, have a disability, and/or are 65 or older–and have limited income and financial resources. ODHS paused closures and restored coverage to 20,000 people found over the income or financial resource limits for OSIP-M. ODHS is updating OSIP-M notices with more information about members’ options, such as spending down excess financial resources. This way, they can make an informed decision and have additional time to report changes and keep their benefits if still eligible. In 2024, these members will get another renewal notice, after which benefits may end if still over the income or resource limits.
What to do if OHP is ending:
- First, review the case summary in your letter to make sure the information used to make the decision was correct. If that information has changed, notify the state. You can call the ONE Customer Service Center at 800-699-9075 (toll-free, all relay calls accepted) or find other options to connect at benefits.oregon.gov. If the information on file for you is correct and you disagree with the decision, you can request a hearing. Learn more about hearings here
- Explore options through an employer. If you, your spouse, or a parent are working, you may be eligible for health coverage through that employer. Talk to your manager or Human Resources department to see if you qualify. You will have a special enrollment period to enroll mid-year due to loss of OHP benefits.
- If you have or are eligible for Medicare: For help understanding Medicare options, go to OregonHealthCare.gov/GetHelp to find an insurance agent or a counselor at the Senior Health Insurance Benefits Assistance Program (SHIBA), or call SHIBA at 800-722-4134. SHIBA counselors and insurance can help you choose the right Medicare options if you’re losing OHP coverage.
If you need to sign up for Medicare for the first time, contact the Social Security Administration (SSA) at 800-772-1213 to enroll by phone or find a local office. You can also enroll in Medicare online at ssa.gov/medicare/sign-up
- Nearly 80 percent of Oregonians qualify for financial help through the Oregon Health Insurance Marketplace. Visit OregonHealthCare.gov/WindowShop to answer a few quick questions and find out how much you can save and how much coverage may cost you. You can also call the Marketplace Transition Help Center at 833-699-6850 (toll-free, all relay calls accepted).
- Need free local help figuring any of this out? Visit OregonHealthCare.gov/GetHelp to find professional help near you.
Find help for renewing your benefits
- Learn more about how to renew your Oregon Health Plan medical coverage.
- Call the ONE Customer Service Center: 800-699-9075 (all relay calls are accepted, and help is available in multiple languages).
- Stop by or call a local office. People can find their local office at: https://www.oregon.gov/odhs/Pages/office-finder.aspx
- Visit a community partner for free, in-person help. To find one near you visit OregonHealthCare.gov/GetHelp(English) or orhim.info/ayuda(Spanish).
ODHS and OHA encourage members to protect their benefits
The large number of OHP renewals, along with renewals of long-term services and supports, may cause greater wait times, delays, and possible interruptions to people’s OHP benefits. OHP members are encouraged to respond as quickly as possible after they receive a request for information to avoid any possible delays. The fastest way members can provide an update is by going to benefits.oregon.gov and logging into their ONE online account.
Members can visit KeepCovered.Oregon.gov to learn:
- What to do to protect their medical benefits
- Where to get help renewing their benefits
- How to provide updates when it’s time to renew
- How to explore health coverage options through a job, Medicare or the Oregon Health Insurance Marketplace if they no longer qualify for OHP
Community partners and providers can find resources to support members through the unwinding process at KeepCoveredPartners.Oregon.gov.
The Oregon Health Authority (OHA) and Oregon Department of Human Services (ODHS) are committed to transparency and will continue to send monthly information about medical coverage among Oregonians as the agencies continue to track the programs.