Oregon Health Commission Offers Proposal to Extend Oregon Health Plan Coverage to 42,000 New Enrollees

The Oregon Health Services Commission has proposed a plan that would expand eligibility for the Oregon Health Plan, which provides health insurance to low-income and disabled individuals, to cover an additional 42,000 residents next year -- but the proposal would require a reduction in benefits for about 25% of the program's enrollees, the Portland Oregonian reports. The Oregon Health Plan currently covers about 373,000 state residents. In July, Oregon state lawmakers passed legislation (HB 2519) to extend Oregon Health Plan coverage to additional uninsured residents and limit benefits for enrollees not categorically eligible for Medicaid, such as single residents and couples without children. The new law divides the Oregon Health Plan into two plans: OHP Plus, which would cover individuals categorically eligible for traditional Medicaid, and OHP Standard, which would cover the population of Oregonians who became eligible after the state "expanded" Medicaid coverage in 1994. Currently, the Oregon Health Plan allows non-Medicaid eligible individuals earning up to 100% of the federal poverty level, or $17,650 annually for a family of four, to enroll; the new law would expand eligibility for non-Medicaid enrollees to 185% FPL, or $32,652 annually for a family of four. However, the commission must develop a proposal to meet the requirements under the new law without "adding a penny" to the state budget. The commission's proposal would reduce OHP Standard benefits to 78% of the current level and require OHP Standard beneficiaries to contribute copays. "In other words," the Oregonian reports, for every dollar spent on OHP Standard patient care, the beneficiary would pay about 22 cents. The new program structure, which requires federal and state approval, will likely take effect in October 2002 (Colburn, Portland Oregonian, 10/26). For further information on state health policy in Oregon, visit State Health Facts Online.