March 2015 Cover Oregon Consumer Advisory Committee Report

Cover Oregon and the current Oregon Healthcare Exchange under the Affordable Care Act

by CAC member Roberta Hall

On Friday, Feb. 27, Cover Oregon’s Consumer Advisory Committee (CAC) met for the last time. The place was the Durham headquarters of Cover Oregon, soon to be dissolved, though the space will be used for several more months. The exchange is not by any means abolished, however, as its activities will continue under the Department of Consumer and Business Services, the state’s largest regulatory agency. (This transfer occurred about a week later.) The important points that the public should know appear to be these:
1. Cover Oregon costs have been reduced significantly. In 2014 the budget was 90 million dollars, of which 80 million were spent, whereas this year the budget is 15 million. Last year, the average cost per enrollee was $48, and this year it is $10. Last year, enrollment was done with both paper and online techniques developed under contract to the state of Oregon, whereas 2015 enrollees used technology developed by the federal government (
2. The King v. Burwell case, heard in the Supreme Court on Wed., March 4, is a legal challenge to federal tax credits offered in the 2010 Affordable Care Act (ACA). It applies to states that did not set up their own exchange; however, Oregon is one of 16 that did. Oregon continues to run its own exchange, albeit using technology developed by the federal government. Still, if the plaintiffs win, and tax credits are not provided in the other states, it would change the ACA’s impacts dramatically.  Regardless of the outcome (expected in June of this year), the extension of Medicaid to persons with incomes less than 138% of the federal poverty level is not affected by the suit. Oregon’s Medicaid system, OHP, is now administered by the Oregon Health Authority (OHA).
3. Once again, at the 11th hour, the OHA extended the deadline for OHP fast-track enrollees to renew their coverage; “fast-track” refers to automatic enrollment because of prior income-certification through the food-stamp program. The previous deadline was 2/28, but that has been extended to March 31. It was estimated that the remaining fast-track population who need to act before the 3/31 deadline is about 32,000. There has been a backlog, but the OHA has announced that it is hiring more call center staff to address that serious problem.
4. One of the obligations Cover Oregon staff are working on, in addition to clearing up problems that the technology collapse caused earlier, is getting the small business healthcare insurance program (SHOP) online. Right now, there is a manual process in place until a permanent solution is found.  You can find out more here. Employers with 1-50 employees face no penalty for not providing insurance, but it is my understanding that they can use the program if they wish, and some have been using it.  Starting in 2016, employers with 51-99 employees will be required to provide insurance.  Employers with 100+ employees are supposed to offer coverage to 70% of their employees this year, 2015.
Ten members of Cover Oregon’s CAC attended the Feb. 27 meeting, seven in person, and three online. Much of the meeting was given to a report and Q and A with Director Aaron Patnode.  Alicia Blevins discussed income tax forms pertaining to the individual insurance obligation and Qualified Health Plans (1095-A); next year a tax form (1095-B) will also be sent to people enrolled in a government-sponsored plan like OHP.  Joel Melton and D’Anne Gilmore from the Department of Consumer and Business Services, together with Director Patnode gave an update on the apparently amicable transition process. Cover Oregon staff members Rachael Oh, Kelly Harms, and Cherie Miller ran the meeting and performed recording and online activities. CAC members thanked them and Director Patnode for their work, and expressed regret that these employees had in effect been held accountable for problems that they had no control over.
Please note that Cover Oregon employees are not state employees, so they will not be transferred to other state jobs, nor do they have PERS. The director of the agency where the exchange is now housed did not keep director Patnode on staff after the take-over, and the agency is laying off about 50 more in March; several current Cover Oregon staff will continue, perhaps through June. I, for one, appreciate their service and believe that the successes the exchange has had in extending healthcare coverage to many more Oregonians – perhaps approaching half a million – are due to their efforts and dedication.
Advocacy groups such as Mid-Valley Health Care Advocates need to follow these changes as they unfold in order to advise people correctly as well as to learn more about the complexities of making changes in the structure of the state’s healthcare-related programs.

Roberta Hall, member, Cover Oregon CAC, March, 2015

Information About Signing up for Health Insurance, and Renewing OHP

From the Community Partner Outreach Team, here are some tips to help with your application:

On the question on application about current health coverage, when you fill out an application on, one of the questions asks you about your current health coverage. This only refers to private insurance. It does not refer to the Oregon Health Plan
or Healthy Kids. Please put "no" if the only insurance you have is OHP or Healthy Kids. Answering
 "yes" may result in an incorrect eligibility determination.


Many OHP members will received or have received a letter reminding them to renew their coverage. Waves of notices were sent to fast-track individuals on Friday, December 12, reminding Oregon Health Plan members to renew their coverage. Please note: Due to the need  to get reminder notices out as soon as possible, the Oregon Health Authority was unable to match renewals already submitted for processing with the reminder mailing list. Therefore, members who have already responded to their initial renewal letter may receive a reminder notice. If they have submitted their application, they have done what they need to do, and their benefits will continue while OHA processes their  application. These members do not need to call Customer Service.

OHP members will remain covered through January 31, 2015 while their renewal applications
are processed. Members should still submit their renewal applications as soon as  possible. Right now, and through the end of the year, many Oregon Health Plan  members are scheduled to renew their coverage. This means that there is an extremely large number of paper and online renewal applications still being processed for the months of November and December. Not all renewal applications can be processed by the time many members are scheduled to lose their OHP coverage on December 31. This may cause a disruption in a member's care and is counter to our goals of ensuring people have coordinated and continuous care. Therefore, to ensure that members can continue to access care while their renewal applications are processed, their coverage will continue through January 31, 2015.
If they are part of a coordinated care organization, their CCO enrollment will also
continue through January 2015.

* Anyone who received an expedited or full application renewal letter and has not
already taken action should do so immediately so there is no gap in coverage. Members
should follow the directions in their letter for the best way to renew by the end
of the year. OHA will notify them once their application has been processed.

* Members who already submitted a renewal application do not need to call OHP Customer
Service. They will process their application as soon as possible. Their benefits will
remain open while their application is processed. OHA will send them a letter after
we process their renewal application.

NOTE: Not all fast-track members will have their coverage continue. Some fast-track members will still lose benefits on December 31, 2014.
* Fast-track members who already submitted a renewal application and who no longer
qualify for OHP coverage
* People in the MAGI Adult program, and who are also receiving Medicare, per federal

Exceptions to the December 15 deadline to enroll in a Qualified Health Plan through
People who are closed or denied OHP have until the end of the month to choose a
Qualified Health Plan that starts on the first of the next month. This is because
they lost their "Minimal Essential Coverage".

Some callers tried to reach by phone on December 15 and were given
the option to leave a message due to the high call volume. When these applicants
 get a call back from customer service, they will be able to enroll
in a plan effective January 1, 2015.

Expect full 45-day processing for applications

As we mentioned above, many Oregon Health Plan members are renewing their coverage.
Due to the volume of applications being submitted, it is appropriate to expect a
 full 45 days for processing. This includes the online PDF or the paper application.
Please keep this in mind as you consider follow up.

More information at, Oregon Health Authority, or your county Health Department.