OREGON HEALTH ACCESS PROJECT
Expanded Access
Coalition Meeting
June 22, 2004,
10:15-11:55 a.m., OHP Central Processing
MINUTES
Attending:
Linda Herman (Clackamas County Health Dept)
Kaaren Driscoll (OHSU)
Rhonda Walker (OHAP/LC-CKF Coalition)
Peggy LaCombe (Native American Rehab)
Katie Gauthier (Oregonians for Health Security)
Ellen Pinney (OHAP)
LoriAnn Sheridan (OHAP-CKF)
Laura Sisulak (OPCA)
Jennie Hamilton (OPCA)
Michele Wallace (DHS)
Laura Brennan (DHS)
Carol Simila (OR Insurance Division)
Liz Baxter (OHPPR)
Marcie Sugarman (Multnomah County Health
Nancy Weed (OR Hunger Relief Task Force)
Lindsay Couch (LaClinica del Carino)
Nancy Abrams (DHS Public Health)
Karen House (DHS)
Kristi Jamison (Central City Concern)
Laura Chenet Leonard (Central City Concern)
Sandy Spoor (Central City Concern)
Heather Dominique (Central City Concern)
Jo St. Clair (OHSU)
Karen Berkowitz (Oregon Law Center)
Stacy Hall (Outside In)
Kristen Saxton (Outside In)
Nancy Horn ( OMAP)
Jim Coffee (CFHC)
I. Call To
Order & Introductions - Jennie Hamilton called the meeting to order at
10:15 a.m., Introductions followed.
II. Disability
and OHP Plus: How are OHP Standard enrollees being screened for Plus before
being dropped from Standard? - Jennie
addressed the template letters for enrollees with cognitive disabilities and the
issue of re-enrolling OHP clients. Karen
Berkowitz explained the letters not only apply to enrollees with cognitive
disabilities, but also enrollees with physical disabilities or mental
disabilities, such as depression, that affect major life functions.
Ellen Pinney expressed concern that very few people have applied for this
accommodation to maintain enrollment although they’re in arrears with premium
payments. Michele Wallace said
Carolyn Ross is currently working on the policy relative to the accommodations,
and as of yesterday, there have been 38 requests received since February 20.
Of these, five have been denied and one has other issues they’re
dealing with.
Jennie questioned how an application will be processed when the enrollee
marks on the application that they have a disability.
Michele explained after July 1, the application will be forwarded to
Seniors & Persons with Disabilities (SPD) to review for OHP Plus
eligibility. Jennie questioned the
definition of disability. Michele
explained the green addendum gives examples of disabilities on it.
Karen added that the state has 45 days to process applications, and
failing to do so, the client should request a hearing.
She added that current drug users do not qualify for accommodate; they
must be in recovery. A representative from Central City Concern pointed out a
client who was applying for OHP Plus was told it could take six months to make a
decision. Michele said she would
follow up with Nancy Talbot on this issue.
Marcie Sugarman shared her concerns about how challenged a person must be to qualify for OHP Plus. Karen explained the standard for OHP Plus is qualification for SSI and it depends on the age of the individual. She added if under the age of 50, it’s more difficult, and over 50, it’s easier. Michele suggested if an individual is denied OHP Plus, they should request a hearing. Jennie asked if a hearings officer could attend the next EAC meeting in July to answer questions about the hearings process.
Michele said they are sending out all cases involving child welfare and
public assistance back to the field offices to handle. Karen said adaptive functions may be considered,
but may require a hearing. Ellen
pointed out that according to the state, the July 1 cutoff does not apply to
people with cognitive or physical disability accommodation letters submitted,
but it’s important to get folks reinstated before their six months run out.
She added the template letters are posted on OHAC’s website. She asked
about the state screening enrollees for OHP Plus before disenrolling.
Karen briefly addressed this issue, stating the safest action is to apply
for a hearing within 10 days of notice. Michele
explained there are two deadlines, 10 days for benefits and 90 days for action
to be taken. Karen explained that
if a client hasn’t applied for SSI, the State determines disability; if the
client did apply for SSI, the State has to recognize the disability.
She added determination must take place within 90 days from application.
If a new condition, one can still get a determination from the State,
which approves 36% of the cases on first application.
III. Premium Sponsorship – New model development - Jennie pointed out there was a frenzy of activity last week to get premiums paid on time. Ellen explained that every county wishes to support premiums, but there’s no vehicle to pay. She shared the fear that if other countys don’t pay, the 24,000 covered OHP Standard clients will all be from Multnomah County since they have been so good in paying premiums monthly. She added Lynn Read agreed to have a meeting next week to discuss the premium payments and the concerns about the discrepancy in numbers. Liz stated a lot has become clearer over the past month and the data has become more clear. Ellen stated the counties that got premiums paid this month included Clatsop, Klamath, Lane, Marion, Polk, Linn, Lincoln, Benton and Multnomah, and Jennie got a check into Earhart on Friday.
Liz addressed the three key issues: (1) no effective vehicle to get information out to those who wish to contribute to premiums; they need a master list; (2) need to identify groups qualified to act as a sponsor organization and there’s criteria needed; and (3) there are flaws in OMAP’s data. She suggested using May and June’s data to raise money for premiums. She also addressed three cautions: (1) Multnomah County will be the only county covered unless there’s a statewide effort to create a pool to support premiums; (2) an issue the premium group has been grappling with is the need to involve clients because we’re adding to their lack of credibility, and, in fact, damaging their credibility; and (3) as long as we continue with this approach, there will be an increase in the potential of maintaining people on OHP who don’t what to be on the plan and paying for higher income individuals and not the most vulnerable.
Ellen stated Lorey Freeman is pursuing a lawsuit on premiums at this time. Laura Brennan stated there are some people who want to contribute to the cost of their services, and just because they are eligible for OHP, we should not assume they cannot pay their premiums. Ellen shared her concern that Earhart receives $3.00 for every premium paid. She added Kevin Earls of the Oregon Association for Hospitals & Health Systems (OAHHS) has tried to get the numbers to get a statewide pool established. Liz explained what Kevin is doing – sending out a letter to all hospitals around the state stressing the understanding that this is a statewide pool they would be contributing to beyond their own clients. She added that hospitals don’t want to be the only funders, and Earhart has been asked to provide a list of every third party who has paid premiums. They should have the list next week.
Ellen stated it is illegal for Outside In to pay premiums for their clients. She asked if anyone knows of someone in the countys that were covered this past month with premium payments was disenrolled, to report it. She added the data from OMAP should be available July 6th. She further explained that OMAP collected funds the past two months to pay premiums, but has to discontinue at this time. Liz explained that it’s about donations; they can be received from providers as long as the amount is less than 25% of the total revenue of the sponsoring organization. Ellen added that Mary Lou Hennrich of the Community Health Partnership has indicated they will only cover Multnomah County. Liz said she would be willing to talk with any organization interested in serving as the statewide sponsor. LoriAnn Sheridan suggested approaching the Oregon Community Foundation.
Kristi Jamison suggested having Earhart at the table or at least keep them on radar. Liz agreed they need to deal with accountability, data and the reporting of Earhart. Kristi suggested finding a non-profit to market premium assistance statewide. Linda pointed out there has been too much confusion: waivers then no waivers, paying premiums with clients getting medical cards, and if a county doesn’t pay the premiums, the client gets dropped, and now people’s premiums are being paid unbeknownst to them and they’re receiving medical cards – creating a lot of confusion. Liz suggested teaching people not to trust communications from OMAP due to the confusion of receiving disqualification notices and medical cards. She added that it may be a good idea to give people the opportunity to ask for help rather than automatically paying their premiums. Ellen pointed out the model has to stop on August 1. Liz said she was uncertain of that date. Ellen added the rules state that if an entity received funds from Medicaid, they cannot donate to premiums, and a sponsorship organization cannot receive funds from an organization receiving Medicaid dollars. Liz indicated the rules for provider donations are posted in the Federal Register. She will also be getting a list of all the premium sponsors in the state from Earhart in the near future, so they may have a better idea who to approach.
Karen pointed out that relative to premium sponsorships, it doesn’t matter where the money comes from for a statewide pool, however, it is illegal for a provider to only cover their own client list. She suggested having clients apply for scholarships for premiums. Ellen questioned what organization could handle this, adding there may be significant costs involved. LoriAnn suggested approaching the food banks or community action agencies.
IV. CAWEM - Jennie addressed the notices going out for CAWEM, which were very confusing. She added it’s on hold since the notices were not clear. She added the card indicated pregnant women will be dropped as well as adults and didn’t distinguish between OHP Plus and Standard. She explained pregnant women are covered for the delivery of the baby and children are covered for life-threatening illness or emergency. There is also retroactive eligibility for OHP Plus for CAWEM. Any CAWEM adult now on OHP Standard must re-enroll just like the Standard population or they’ll lose coverage indefinitely. After July 1, there will be no new enrollments for CAWEM adults on Standard.
V. New OHP Application – Ellen told the EAC members a new OHP application is currently in the works. Nancy Horn said OMAP will be sending out the application this week to the workgroup for review via email. She added it needs to go to the printer by July 10 and will be effective August 1. LoriAnn said CKF wants to have a focus group of clients in Medford review the application before it’s completed for printing. Michele pointed out the 415 application for food stamps has been printed and distributed to field staff, and will not replace the new OHP application.
Ellen read an email Jennie received from Klamath Falls, indicating clients who process their applications through the local AFS offices were not receiving re-application packets, but those who are processed through the Salem office do receive them. Michele will check into it.
VI. Enrollment Numbers – Ellen pointed out Standard enrollment is still growing. She added the Legislature reconvenes in January and there should be an effort to get the cigarette tax reinstated at that time to support OHP. Michele suggested not relying on the 24,000 enrollment number without the provider tax, which is still awaiting CMS approval. Jennie suggested clinics invite local legislators to their clinics to see what they’re experiencing. Ellen pointed out FHIAP is addressing a children’s insurance product, however, employers are reluctant to share FHIAP information with employees. She shared her concern about the reallocation of Medicaid dollars when the most vulnerable are getting kicked off OHP Standard while FHIAP is covering people up to 185%. .
Jennie addressed the outcomes of a work group relative to undocumented CAWEM pregnant women. Evidently, there is a movement to draw down SCHIP dollars to support this population since President Bush recognizes a fetus as a person, and under that guideline, should receive prenatal care. She added Washington and California recognize this and provide prenatal care to pregnant CAWEM women.
Relative to outreach efforts, LoriAnn said Glenna from the Eastern Oregon CKF coalition informed her their health department paid to reproduce 2600 copies of the Enroll Now flyer to distribute. Peggy LaCombe said they have been hosting picnics for their Native American clients, using these opportunities to do OHP outreach. Ellen announced the Best Practices Roundtable event, which will take place tomorrow 11:00 a.m. to 2:00 p.m. at Pringle Park to discuss effective outreach and enrollment efforts.
Ellen added it was agreed at the last COER meeting that a small workgroup would be created to discuss the contracts that all outreach/enrollment sites must sign, which suggests they provide assistance to all OHP eligibles in their communities as opposed to just their own clients. Linda said that’s what she has always understood. Ellen said she’s been told she cannot get the names of the people who have date stamps because they don’t want their names distributed. Nancy Horn explained that they have included some clarifying language in the contracts and the State is creating a database of all who are willing to have their information shared, asking them in the letters that went out with the applications. There are some who have indicated they did not want their information shared. Ellen said she is hopeful she can create a network in Marion/Polk Counties from the meeting taking place tomorrow.
VII. Announcements & Adjournment
A. Next
meeting: July 27, 10:00-12:00
p.m., DHS Parkway Bldg., Upstairs, Room 6
Note: Limited
parking; overflow at Fred Meyer across the street
B. Adjournment:
11:55 p.m.
Handouts:
OMAP Medically Eligibles Data (May 2004) OHP Outreach sheet
OHP Standard Medically Eligibles Data (May 2004) Premium Delinquency letters for cognitive disabilities
May 2004 EAC minutes OHP Chronology sheet
OPCA Enrollment postcards Best Practices Round Table flyer
Refined OHP Standard Benefit Package flyer ENROLL NOW flyer
EAC
Minutes-062204.doc
Recorded by LoriAnn Sheridan, OHAP