Income Increases, Complicated Application Prevent Oregon Health Plan Members From Re-enrolling, Study Finds

"Rapid turnover" among those covered by the Oregon Health Plan is leading to coverage gaps, a study from Providence Health System found. The Portland Oregonian reports that 43% of people covered by the plan, the state's public insurance program for low-income residents that insures 260,000 Medicaid beneficiaries and 90,000 other residents, exit the program within a year of enrolling, typically due to increases in income. To qualify, a family must not earn more than 100% of the federal poverty level, or $17,650 annually for a family of four, and also must not possess more than $2,000 in assets, excluding a house or car. While an increase in income often "disqualifies" people from the state program, it is usually insufficient to purchase insurance or pay for medical expenses out of pocket, the study found. Of those leaving the plan due to changes in income, 71% stay uninsured, and more than half delay medical treatment. The report found that 25% of those who left the program said they "skip[ped] urgent care." The study also found that the "new eligibles," or those who became eligible for coverage when the program was expanded in 1994 to include Medicaid patients, are the "least likely" to remain in the program. Only 24% of such members stay in the plan for a full year. Joan Kapowich, program and policy manager of the state Office of Medical Assistance Programs, said, "This is the problem with poverty. You get a better income, but you lose your health insurance."

Improving Continuity of Coverage
To "improve continuity" of enrollment for the health plan, the report recommended extending the eligibility period from six to 12 months and simplifying application forms. The Oregonian reports that "burdensome paperwork," such as the eight-page application, is "blamed" by one in six of those who become ineligible for their failure to re-enroll. The study also suggested making coverage "portable," which would allow seasonal workers to keep coverage despite fluctuations in their incomes. The Oregonian reports the state is already looking to "streamline" applications and has starting using "name-based bar codes" on the forms to simplify tracking. While expanding coverage could be a "budget buster," according to Kapowich, the state Legislature last month approved a plan to increase the Oregon Health Plan income eligibility limit to 185% FPL -- a move that could add 42,000 people to the program. To pay for expanded coverage, the state would "trim" benefits. Although the changes are projected to take effect in October 2002, the Bush administration must first approve the plan (Colburn, Portland Oregonian, 8/1). For further information on state health policy in Oregon, visit State Health Facts Online.