Expanded Access Coalition Meeting

March 23, 2004, 10:00-12:00 p.m., OHP Central Processing

MINUTES

Attending:

Linda Herman (Clackamas County Health Dept)                Sandra Callahan (OHAP)

Judi Dains (Multnomah County Health Dept)                      Rick Bennett (AARP)          

Kristi Jamison (Central City Concern)                                 Tim Miller (OHAP)

Rhonda Walker (OHAP/LC-CKF Coalition)                        Sandy Wood (OMAP)

Katie Gauthier (Oregonians for Health Security)                   Joy Soares (CareOregon)

LoriAnn Sheridan (OHAP-CKF)                                         Nancy Horn (OMAP)

Ellen Pinney (OHAP-CKF)                                                 Jennie Hamilton (OPCA)                                  

Carol Simila (OR Insurance Division)                                   Erica Hetfeld (Providence/PacificCare)

Carolyn Ross (DHS.CAF)                                                   Ellen Gradison (Oregon Law Center)

Ann Strada (Providence)                                                   Rev. Carolyn Palmer (Special Concerns Ministry)

Wanda Schindler (OHAP)                                                  Kaaren Driscoll (OHSU)

Kevin McAndrews (PeaceHealth)                                       Kristen Saxton (Outside In)

John Holmes (NAMI-Multnomah Cty)                                 Heather Dominique (Central City Concern)

Larry Etcitty (NARA-NW)                                                 Lisa Joyce (DHS)

Jim Edge (OMAP)                                                              Karen House (OHP Central)

Jerry Kolasinski, Multnomah Alliance for the Common Good

 I.          Call To Order & Introductions:  Jennie called the meeting to order at 10:00 a.m., Introductions followed.  

 II.         OMAP Proposed Rebalance:  Jim Edge gave a brief overview of the restructuring of the health plan and the history leading up to the current activities coming before the Emergency Board.  He pointed out after the Legislature came up with a revenue package dependent upon a temporary tax increase and the waiver was submitted, the referendum, Measure 30, was brought before the voters and defeated, leaving the state without the money to operate the OHP.  He added the state has not received approval of the waiver, which is just as well since the state cannot afford the program that was envisioned at the time the waiver was submitted.  He explained the disappropriation bill that was triggered by the failure of the ballot measure, which would have essentially wiped out the expanded OHP, returning the state to traditional Medicaid.  However, the Governor set his priorities to include maintaining OHP Plus at the current level of services, which is a higher level of optional services than federally mandated, as well as pregnant women (PLM) and children (SCHIP) to 185% FPL.  He explained the governor could not find a way to save OHP Standard or the MEDS program.  The DHS budget folks were charged with finding the funding to support the governor’s priorities which was submitted by Gary Weeks last week.  This will go to the Emergency Board (E-Board) on April 8-9 as they deal with revenue issues between sessions.  He pointed out that all agencies are required to present rebalance plans relative to their current funding, projections and surpluses, which will be adjusted to meet the budget.  He stressed this is an important E-Board meeting as they deal with post-Measure 30 results, especially as it affects OHP.   

Jim explained there has been some savings in OHP since caseload has dropped considerably.  The intent of the DHS rebalance plan was to meet the governor’s priorities, and it will go to the Department of Administrative Services before going to the E-Board.  The plan shows the savings found within DHS along with the elimination of OHP Standard, there can be a revenue plan to fund the governor’s priorities.  He pointed out only the Legislature can move funds from one program to another.  Once the E-Board makes their decisions on the rebalance plan, DHS will have better direction on how to move forward.  Then the state will have to begin a new set of negotiations with the federal government, talking with CMS to get authority to move ahead.  Following these negotiations, the state will need to discuss the prospect of saving some portion of OHP Standard, which is planned to be eliminated August 1.  He explained the governor is not willing to use any general funds to preserve OHP Standard, however, if something can be put together with the provider and managed care taxes, some part of OHP Standard may be saved.  At this point, the federal government has not responded to the state’s request to use provider taxes to draw down federal match dollars.  The state is very uncertain whether the federal government will approve as they do not like states doing this.  He stressed the need for the state and the provider groups to come together at the state level.  There has not been any agreement reached yet, but they are having ongoing discussions.

                        Tim Miller questioned whether or not a portion of OHP Standard can be saved with a provider tax without federal match.  Jim reflected on the Medically Needy program in which prescription drugs were reinstated for 300 HIV and organ transplant individuals through general fund dollars (no federal match), explaining it could be done, but it would be very expensive because you only get one third of the money that you could get with federal match.  In response to a question from Rev. Carolyn Palmer about care for seriously ill people, Jim said the state could do this, but uncertain who would determine what categories or illnesses are covered, and there are no general funds to do this.  Lisa Joyce explained the federal government does not allow states to choose categories for coverage.

                        Ellen addressed a national issue in which Senator Rockefeller is looking for a strong Republican co-sponsor for FMAP, an increase in federal contributions to state Medicaid programs.  A $10 billion program, it could bring $10 million into Oregon.  OHAC will be asking Senator Smith for his support on this.  She pointed out, on the House side, they’re looking at cutting FMAP by $2.2 billion, which would translate into $2 million in Oregon.  She added all of Oregon’s Congressional delegation on the House side is supportive of stripping that portion from the bill, with the exception of Greg Walden.  She asked if anyone has connections with Walden, she encouraged them to contact him.

                        Jennie questioned the general fund and the cigarette tax, and if this tax could be reinstated.  Lisa said they are currently going through their legislative concept process, and they are aiming at the reinstatement of the 10 cent cigarette tax.  She pointed out there are a number of programs funded by the cigarette tax so there would be a balancing act.  Jim recommended talking to legislators since this is a legislative process.

                        Lisa pointed out an important restoral in the rebalance is levels 12 and 13 for long term care for 750-1,000 people who had previously received these services.  She added that advocates can remind the legislature of the ground we have lost so far in lost services and lost clients.  Jim added the increased federal match Oregon received for five quarters will expire June 30.  He explained it was for the purpose for states going through difficult economic times.  Oregon’s federal match went from 60% federal match to almost 63% federal match, which helped the state, however, there was a string attached to that – any state that reduced or put restrictions on the population during that time lost their eligibility for that money, and if they drew it down, they would have to pay it back if they changed their eligibility requirements during that time.  If Oregon makes a change in the OHP Standard population, it is making a change/reduction in the population served and would not qualify for the enhanced federal match.  He added Senator Wyden’s office and Senator Smith’s office have questioned DHS on this and DHS explained if the program is going to do Oregon any good, the strings need to be detached from it.

                        Ellen recommended that advocates unite to not only serve the Governor’s priorities, but also to encourage the legislature to find some money to maintain OHP Standard.  She pointed out the provider and hospital tax would only fund half of the OHP Standard population so the state needs to come up with some money.  She asked about Thorne’s recommendation to use levels 12 and 13 as a potential add-back in OHP.  Lisa explained that by not reinstating levels 12 and 13, there may have been a savings of $20 million coming from the prescription drug benefit for OHP Plus.  She explained the money was going back to purchase optional services for OHP Plus without having to hit levels 12 and 13.  Jim added in the final report, levels 12 and 13 can be bought back and there’s enough money for the Governor’s priorities. 

                        Ellen Gradison pointed out CMS has to approve OHP Plus, SCHIP and PLM, asking how likely that would be if the state is not going back to an expansion plan to support the 1115 waiver, unless it’s the FHIAP population they are looking at.  Jim explained the feds have given an indication of where they stand on the current waivers, but no formal approvals or disapprovals on anything. The state knows that the restructuring of the OHP Standard benefit package, which was in HB 2511, would have created a benefit package with limited hospital benefit, but added back mental health and chemical dependency.  The feds seem to be okay with that and have indicated they are likely to approve it.  In regards to the flexibility that was asked for in the OHP Plus population so if the state had budget problems, it could reduce non-mandatory optional services, the feds have indicated they are not willing to give the state that flexibility.  Additionally, although the state requested a 30- line movement on the prioritized list, the feds will only approve a 3-line movement.  The feds are also not okay with the MEDS program.  Reasons for this include the following: (1) in a time of downsizing, why is the state looking to expanding, and (2) most of the people who would qualify from the MEDS program will be picked up by the new Medicare prescription drug program in 2006.

                        Jim addressed the direction DHS is getting from the Legislature, primarily the elimination of OHP Standard.  He explained the history of the Oregon demonstration project that was proposed in the late 1980’s

and implemented in 1994 with the expansion of the population served through OHP Standard.  The rationale was that the state could do things more efficiently and serve more people if CMS approved the waivers to do this.  Now, there’s a concern if OHP Standard is eliminated, CMS may eliminate the demonstration program.  He added if the state loses this, it may also lose the prioritized list, which is about a 7 1/2 % savings overall in cost of traditional Medicaid services, including optional services.  He pointed out Oregon does have an expansion population in serving SCHIP and PLM up to 185% FPL and the federal mandate is 133% FPL.  FHIAP is also subsidizing premiums for employer-based insurance for employees up to 185% FPL, which was serving 2,000-3,000 people two years ago.  During the OHP 2 changes, the program was brought in to the waiver so they could draw down federal match.  Now, they can serve more people, approximately 6,000 people now, and could probably cover 10,000-11,000 in the future.  If OHP Standard is eliminated, the State would try to make the case to the feds that Oregon does have an expansion program through FHIAP.  He pointed out the State is hanging their hat on FHIAP, and if they can save a portion of OHP Standard, they will hang their hat on that also.  He added the current administration is very supportive of private sector programs.  He explained the HIFA waiver template that was part of OHP2, designed by the current administration specifically to allow states to do more with private sector insurance supplements.  He added the state will continue to have the HIFA waiver to continue the federal match on FHIAP, and the feds would continue to see that as an expansion program.

            Jennie pointed out OHAC and OPCA are supportive of preserving OHP Standard, and are concerned that the people who have been dropping off are people living below 50% FPL.  She stressed that the most vulnerable people are falling through the cracks while FHIAP serves individuals up to 185% FPL. 

III.            Provider & Managed Care Tax – Joy Soares stressed the importance of the State making a contribution to maintaining OHP Standard, adding if the State sees FHIAP as the expansion, there’s no plan and the waiver is jeopardized.  She explained the State needs to press hard to get the provider tax approved by CMS.  Jim said the State has weekly calls with CMS on the provider taxes.  Julie Huddleston is the lead person for the state in these efforts.  He added they have not involved the Congressional delegation yet, but may do so following the E-Board meeting.  Lisa added CMS is waiting for the dust to settle.  Jennie said a delegation from OPCA met in Washington DC, urging the Congressional delegation to assist the state, stressing it’s important for all to way in.

                        Kevin McAndrews said Peace Health will support the provider assessment.  Ellen asked if providers and managed care organizations support the assessment on themselves to be used for OHP Standard and the State is not willing to put up any money for standard, where does that leave the providers and managed care plans in terms of supporting OHP Standard.  Joy said they need to know what it will actually cost to bring back OHP Standard and they have estimated it would cost approximately $40 million as a reasonable figure.  Jim said the budget folks have been busy with the OHP Plus population, but will be working on figures for the OHP Standard population.  He added the State thinks the amount of money available from the two taxes is not likely to be enough to cover all of the people currently on OHP Standard.

                        Joy addressed the significant number of people who have disenrolled from OHP Standard, asking if this will jeopardize Oregon authority to get FMAP, if approved by Congress.  Jim explained it’s when the State makes a policy change that restricts population during the time Oregon receives FMAP that may compromise this.  

Rev. Carolyn Palmer asked to receive a list of attendees of the EAC meeting so she might contact them for a sign off letter to the E-Board.  Ellen said she would deal with that, adding the OHAC Board will be sending a letter asking that FHIAP be put on the table since only 2000 of the 6000 people covered by FHIAP live below the Federal Poverty Level while the State is eliminating coverage for the most vulnerable populations.

                        Joy suggested looking at how to address OHP Standard and asked if DHS has looked at lowering the Federal Poverty Level or placing a cap on enrollment in an effort to salvage the program.  Jim explained DHS is just beginning to look at that, and they need a planning process with timelines on how to deal with OHP Standard if it’s going to be eliminated by August 1 and, at the same time, if OHP Standard can be saved, another process to follow.  Lisa added that the Governor has insisted that whatever is implemented must be sustainable.  Jim added that anything DHS does this biennium needs to project out to the next biennium and show it is supportable then.

                        Joy stressed that the provider tax is vital to maintaining OHP Standard, but they need the State dollars to make it whole.  She added advocates need to communicate with the Legislature on the intended and unintended consequences of OHP Standard being eliminated.  The infrastructure of the safety net clinics is at stake as they will be unable to serve all the uninsured.

                        Ellen suggested pursuing a simplified six-month reenrollment application for children in support of the Governor’s priorities.  She addressed what she has heard from Bruce Goldberg and Erinn Kelly-Siel at various meetings in that the Governor is very supportive of transparency, e.g., if you set a policy for enrollment to 185% FPL, you do not set enrollment obstacles or barriers for that.

                        Jim explained that Erinn Kelly-Siel from the Governor’s office is meeting with the hospital association and managed care plans about revenue options as well as meeting with health administrators around the state in talking about the possibility of saving OHP Standard.  In response to the impact of unintended consequences, Jim stated the infrastructure is being dealt with by Bruce Goldberg’s office.  He agreed looking at the consequences are important to look at and needs to happen, however, the State hasn’t got there yet.  Lisa added they are looking at a $1 billion shortfall in the next budget session.  They will be looking at the system impacts of their actions as well as get better positioned to describe policy choices that were made around the birth of the Oregon Health Plan and as it evolved.  She addressed how the mental health infrastructure was devastated when the Legislature eliminated prescription drugs during last year’s legislative session.  She stressed the need to be clear with decisions made over time to develop the system we have today and the economic impacts of the budget cuts to local communities.  Jim stressed they are at the beginning stages of deciding what can be done and if the State can secure federal approvals. 

In response to a question about task forces, Jim said the State has a new Health Policy Commission with broad representation.  Jennie said the commission is meeting March 31 at 1:00 p.m. at the Capitol.  Ellen asked about the ability of the Joint Committee on Human Services to influence the options for OHP.  Lisa said they are not the place to put on pressure.  It was pointed out advocates should contact the Speaker’s office and the E-Board members.

Ellen asked if OHP Standard is eliminated on August 1, how does it play out for clients since OHAP is continuing to pursue enrollment of clients.  Jim said they have folks looking at when notices need to go out, complying with deadlines for proper notice.  Carolyn Ross explained that they are working on this and the notices are being drafted in her policy shop, but waiting for certainty after the E-Board meets.  She added they are screening all clients to see if there is a program they fit it before any notices go out.  They’re still discussing when the shut-down will be for OHP Standard enrollment prior to August 1. 

Jennie asked if advocates are successful in getting out the message that the State needs to pony up money for OHP, if Jim or Lisa had any idea where the money could come from.  Jim said that would be entirely a legislative decision and it may be the only option is to look at trades.  Lisa added members of the E-Board are not pleased with the prospect of OHP Standard going away and will be looking at it closely.  Joy pointed out there is a way to make OHP Standard whole with State dollars through trade offs.  She agreed the Legislature is conflicted themselves.  She suggested speaking strongly about the need to keep OHP Standard.                       

IV.              OHP/SCHIP & FHIAP Enrollment Numbers – Carolyn Ross told the EAC there are currently 45,000 enrollees on OHP Standard and they are currently at 31 days out in processing applications.  The processing center has been losing about three staff per week to promotions, 24 per month.  They also cannot hire right now, and if OHP Standard is elimianted, it will seriously impact the processing center.  She added there is talk about whether or not they will need a processing center or just process out of local field offices.  If OHP Standard stays, they are concerned about staff.  Currently, 20,000 clients get their services in field offices.

V.                  

                        Ellen addressed the letter she circulated regarding getting social service agencies, providers and clients with disabling conditions getting re-enrolled through reasonable accommodation.  Rev. Palmer shared an experience of families who have been told at field offices in Portland, they are not qualified for OHP based on ethnicity, race and age questions they received.  Carolyn said she would check into it as this is not normal screening.  Ellen Gradison explained they must be permitted to get an application regardless of their status.

                        Karen House said OHP Central has approximately 11,000 applications in their backlog, but the number varies.  They have bringing in temps and working weekends to keep up with the applications.  She stated the pending rate has been going down, to about 22-25%. 

                        Rev. Palmer addressed the occurrence of people losing their prescriptions.  It was explained the Legislature did that last year, however, it was reinstated.  Ellen Pinney said she would talk with her later about it as there’s evidently misinformation her clients are getting.

                        Kristi recognized OHP Central Processing for reducing their processing time from two months ago.  She asked how Central City Concern can assist with processing as an outreach center.  Carolyn said all ideas could be sent to her as she welcomes them.

                        Carolyn asked about the ADA situation in which she needs clarification on a client.  It was recommended she contact the client as well as the county health department.  Ellen Gradison suggested not depending on a roommate’s ability to pay a premium on behalf of a client with disabilities.  Ellen Pinney suggested a change to the letter so it addresses both the case worker/agency as well as the client.  She asked Carolyn if her group is attempting to identify clients who may have a disabling conditions, preventing them from paying their premiums on time.  Carolyn said they are working on it.  Rhonda said she has been using the waiver form for clients and it has worked well.

                        Tim questioned what created the decrease in the pend rates.  Karen said they have been doing alot of trainings, internal reviews, meetings with workers as well as the outreach efforts ensuring all the information is retrieved for the applications at the onset. 

V.            Premium Sponsorship Update – Ellen addressed the OHP enrollment and disenrollment data relative to individuals dropped due to failure to pay premiums.  She explained that anyone can pay premiums for clients who cannot pay their own.  Kevin questioned the total number in the data.  LoriAnn will check on.  Kristi said the sponsorship committee met with Nancy Rudolf and Bruce Goldberg about premium sponsorships and dealing with the state.  She explained that Central City Concern is giving funds to Community Health Partnership to pay premiums on behalf of their clients.  The clincher is in the details in identifying individuals who need premiums paid on their behalf, which the state is uncomfortable with.  Ellen explained the issue is a federal one relative to self-serving by organizations providing direct health services. 

VI.            Announcements & Adjournment

A.  Next meeting:  April 27, 10:00-12:00 p.m., DHS Parkway Bldg., Upstairs, Room 6

Note:  Limited parking; overflow at Fred Meyer across the street 

B.  PeaceHealth:  Kevin addressed the outreach efforts PeaceHealth did in having a health fair in Cottage Grove.  They had financial counselors available and reached 55 people, 20 of which were children.  They are going to do a three-day event in Eugene a week after Covering The Uninsured Week.  They will be sending out 10,000 postcards and plan on doing this on a quarterly basis.  He stressed that promotion of access is part of PeaceHealth’s mission.  Ellen asked to receive their outreach materials. 

C.     Cover The Uninsured Week – May 10-16; Jennie solicited participation in outreach events. 

D.     On-Line OHP Application – Ellen announced the OHP application packet is available on-line on the DHS website and OHAC’s website at www.ohac.org. 

E.      Federal Bill on Serving Uninsured – Rev. Palmer announced there is a federal bill which may pass prohibiting hospitals from charging the uninsured. 

F.      Medicare Road Show – April 2, First Unitarian Church in Portland, 3:00-4:30 p.m., by Families USA. 

G.     OPCA Media & Advocacy Training – May 20, 8:30-4:30 p.m., Doubletree Hotel, Lloyd Center. 

H.     Adjournment:  12:00 p.m.  

Handouts:

OMAP Medically Eligibles Data (Feb 2004)                                 Medicare Road Show flyer                           

OMAP Medically Eligibles Data Sheet (Dec. 2002-Feb. 2004)     OHP Standard Medically Eligibles Data 

     February 2004 EAC minutes                                                          OPCA Advocacy Training flyer

     Premium forgiveness letter templates                                               E-Board Letter from Gary Weeks

     Joint Committee on Human Services agenda                                    OHP Enrollment & Disenrollment data

     OPCA newsletter

EAC Minutes-032304.doc                                                                                                             Recorded by LoriAnn Sheridan, OHAP