Oregon officials have extended health care benefits to thousands of young adults with special needs.
A new pilot program is offering free Medicaid benefits to about 4,000 19- and 20-year-olds with intellectual, physical or mental disabilities or certain mental or medical conditions like asthma and diabetes. Normally, they wouldn’t qualify because they or their family make more than the Medicaid eligibility limit, which is 138% of the federal poverty level, or nearly $20,800 a year for one person or more than $35,600 for a family of three. The program has increased the limit to 205% of the federal poverty level, nearly $30,900 a year for one person and over $52,900 for a family of three.
The program offers expanded dental and vision services, like crowns, braces and contact lenses, and allows those who qualify at 19 and 20 to keep the benefits until they’re 26. An estimated 15,000 19- and 20-year-olds on Medicaid will benefit from the program, keeping enhanced benefits until they’re 26. Kristen Lambert, a spokesperson for the health authority, said the agency plans to add more ages in coming years until age 26 is included in the eligibility requirements.
One in five children in Oregon has a special health care need: nearly 174,300 people. Across the state, Medicaid serves about 1.4 million people.
The program is part of Oregon’s goal to widen access to health care insurance and eliminate inequalities in health care access. It has set a goal of eliminating barriers to health care statewide by 2030.
“As people with special health care needs age, they can face changes in insurance coverage that disrupt access to essential care,” said Steph Jarem, an OHA policy director. “Our goal is to increase access to affordable care and bridge the gap between pediatric and adult care. With these new benefits, young adults with complex health care needs will be able to access their regular care as they transition to adulthood.”
The benefits include rent assistance to keep people housed and nutritional support along with climate devices, like heat pumps or air conditioners, to protect them from extreme weather. Those benefits, which aim to ensure that people don’t lose access to care because of their living conditions, are part of new services offered by OHA to some Medicaid members under a pilot approved by the federal Centers for Medicare and Medicaid Services.
The Oregon Health Authority has a history of Medicaid innovation, including setting up a new Bridge Plan that provides Medicaid benefits to people who earn between 138% and 200% of the federal poverty level. That plan, which went into effect last July, aims to prevent people cycling on and off Medicaid as their income changes. OHA officials estimate that the bridge plan will cover 100,000 Oregonians by 2027.
The new extended coverage for young adults is a first in the country, the health authority said, just as the state was the first to offer rental assistance to Medicaid members statewide. The agency expects these added benefits to improve health outcomes in Oregon, and that, health officials say, will bring down health care costs overall. When health problems fester, they become severe and cost more to treat.
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There are two articles here that illustrate the ongoing access problems for dental that keep getting talked about, recipient complaints about access to care. This flies in the face of continued rate cuts for dental. First of all the claim that dental is not doing enough "work" may not acutally be correct. What should be said not enough work is being done for the rate that the government is willing to pay. If I am correct the actuaries use the 51st percentile to apply to the procedures to determine the amount of work? If they used the 65th percentile there would be no need for the 12% rate cut. One article is about the need for more staff and the other issue is covering more people, be it a complicated group, namely disabled teens. I am not saying they do not need coverage, I am just saying the two issues complicated by the continued actuarial application of rate cuts are not going to make access to care better. I have watched as the OHA has piled more and more stuff to do for dental in the face of this. I have been around long enough to remember the original rate setting debacle for dental in the beginning where the rates were so low no one would participate so had to be reevaluated by using ODS commercial dental rates. Are we there again? When I started dental was around 13.5% of the total Medicaid budget, today it is less than 5%. Food for thought at what point to we pile on and reduce the rates and the system collapses? Especially when we do not recognize and implement we now have new and better systems and medications that reduce the dental infections that cause the need for fixing the results of these infections.
Mike Shirtcliff DMD