Oregon in top three states protecting medical benefits
SALEM, Ore. — Nearly two-thirds of the way into renewals process following the end of the COVID-19 pandemic emergency, data shows more than 5 out of 6 Oregonians are keeping their Oregon Health Plan (OHP) or other Medicaid benefits.
Oregon’s 85 percent renewal rate is the third highest in the nation according to Kaiser Family Foundation’s comparison of state renewal rates.
There has been a 2.7 percent increase in renewal rates over the last month, due to Oregon restoring benefits for some people whose benefits had previously closed. Between the recent restorations and Oregon’s earlier decision to renew some people expected to retain benefits through the unwinding process, it is likely we will see the renewal rate decline somewhat in future months.
Oregon’s unique steps to keep people covered are also in effect: As of October 31, 14,105 people likely to qualify for Oregon’s Basic Health Program are keeping their OHP until July 2024 when the new program launches.
OHP renewals after the pandemic
During the pandemic emergency, the federal government allowed states to keep people on Medicaid and did not require annual renewals.
With the end of the emergency, everyone who has OHP or other Medicaid benefits 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. People may be asked for additional information, including documents such as paystubs, or to review, sign and return a renewal packet.
OHP renewals so far
As of Nov. 17, 2023, 919,879 people have completed the renewal process. This represents 63.8 percent of all OHP and Medicaid members.
- 783,661 people (85.2 percent) were renewed and kept their benefits. This is a 2.7 percent point increase since October.
- 111,941 people (13.0 percent) were found ineligible. This is a 0.8 percent point decrease since October.
- 16,227 people (1.8 percent) 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. This is a sharp decrease from the 25,714 (3.2 percent) reductions reported in October, largely due to the benefit restorations.
November OHP renewal requests
In November, renewal letters were sent to an additional 140,780 people.
- 7 percent were renewed without any action needed.
- 6 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.
- 3 percent were asked to fill out a renewal form.
- 7 percent had previously reported that they no longer met income limits or other requirements and received a notice that their benefits will be ending in 60 days.
State responds to renewal system issues
Over the last few months 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. An additional 1,700 members found ineligible for other reasons also receive the incorrect approval notice, and had their coverage extended until the end of the year to allow additional time to find other health coverage.
- Correcting or preventing incorrect terminations: Medical benefits were restored for around 1,900 people whose benefits were incorrectly ended in September. 1,226 people also incorrectly received notices explaining that their benefits would end at the end of October, but those closures were prevented. Affected members received new notices in November that their coverage is continuing. 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.
- Restoring Oregon Supplemental Income Program—Medical (OSIPM) benefits: ODHS paused closures and restored coverage to 20,000 people found over the income or financial resource limits for OSIPM. OSIPM 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. Members received a notice in October or November that their coverage was restored. ODHS is updating OSIPM renewal notices with more information about members’ options to potentially remain eligible. 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 they are still over the income or resource limits.
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.
Find help renewing your benefits
- Learn more about how to renew your Oregon Health Plan medical coverage.
- Find a list of all the ways you can get help with renewing your medical benefits at benefits.oregon.gov
- Call the ONE Customer Service Center: 800-699-9075 (all relay calls are accepted, and help is available in multiple languages). Wait times are lowest between 7 and 8 a.m.
- 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).
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.