OREGON HEALTH ACCESS PROJECT
Expanded Access
Coalition Meeting
May 25, 2004,
10:10-12:00 p.m., OHP Central Processing
MINUTES
Attending:
Linda Herman (Clackamas County Health Dept)
Kaaren Driscoll (OHSU)
Rhonda Walker (OHAP/LC-CKF Coalition)
Sandy Wood (OMAP)
Katie Gauthier (Oregonians for Health Security)
Ellen Pinney (OHAP)
LoriAnn Sheridan (OHAP-CKF)
Elena Gainey (VGMHC)
Jennie Hamilton (OPCA)
Michele Wallace (DHS)
Laura Brennan (DHS)
Kelly Harms (IPGB)
Liz Baxter (OHPPR)
Marcie Sugarman (Multnomah County Health
Maria Lopez (VGMHC)
Frank Quevedo (VGMHC)
Carolyn Ross (CAF)
Joyce Clarkson (CAF-SS)
Nancy Weed (OR Hunger Relief Task Force)
Roxanne McAnally (IPGB)
Gloria Rosales (VGMHC)
Maria (WSC)
Glenna Awbrey (HNRS)
I. Call To
Order & Introductions: Jennie
called the meeting to order at 10:10 a.m., Introductions followed.
Jennie also informed attendees OPCA has printed out postcard notices of
upcoming changes and encouraged everyone to take some with them upon departure.
II. Moving OHP
Standard from 100% FPL to 50% FPL – Policy, Process & Timelines:
Carolyn Ross explained the State has found they will be unable to get the
enrollment numbers of OHP Standard clients down to 24,000 by attrition alone by
June 30, 2005. At this time, there are over 50,000 enrolled and it’s expected
to climb this month to 56,000. The
State is allowing clients currently on OHP Plus, who may lose Plus to move to
OHP Standard if they qualify. Also, if someone is in the child welfare system
and their children have been taken away, and they must have medical to keep
their children, the State will be flexible in moving them between OHP Plus and
Standard. She explained the State
is looking at moving the Federal Poverty Level (FPL) to 50% and they’re
currently running the numbers, but it looks like it may not work to get the
enrollment numbers down. She
pointed out the premium sponsorships will continue and co-pays will be
eliminated for OHP Standard clients, so more people will remain enrolled.
Carolyn further addressed the ADA issue relative to disabilities.
She explained out of 22 requests received; 13 were approved; 6 they are
working on; and three they are waiting on.
She added they do not expect to have new enrollments until July 2005 as
it will take the rest of the biennium to get the enrollment numbers down to
24,000. They have discussed how
they will approach this by either open enrollment or waiting lists.
She pointed out the funding to support OHP Standard is totally dependent
on the provider tax and managed care tax since there is no State money
supporting it. Sandy Wood added the provider tax has yet to be approved by
CMS, and if they don’t have the provider tax, the enrollment limitation will
be reduced to 17,000.
Ellen told attendees that through the effort of Lorey Freeman of the
Oregon Law Center, the courts ruled that co-pays were not legal. Carolyn confirmed that as of 12:00 a.m. June 19, there will
no longer be co-pays imposed on OHP Standard clients. Ellen asked about screening for disability and eligibility
for OHP Plus before dropping clients from OHP Standard. Michele said they do this consistently as they review
applications for OHP Standard, looking to see if clients qualify for OHP Plus.
Ellen clarified in asking if the State screens clients on OHP Standard
for OHP Plus eligibility before sending them termination notices.
Sandy said they are working on that now.
Jennie asked if disabled individuals will be determined eligible for OHP
Plus before the federal determination of SSI or SSDI.
Michele said they are processed. Sandy
offered to bring Nancy Talbot, from Seniors & Persons with Disabilities, to
the next EAC meeting.
Marcie asked if the State reduces eligibility down to 30 or 50% FPL, if
current enrollees will be removed. Carolyn
explained when they do the re-determination, if the individual’s income is
above these limits, they will be disenrolled.
Marcie asked if a significant amount of applications are submitted by
June 30, however, missing necessary documentation, if the applications be
accepted and processed. Carolyn
said the applications would be processed. Michele
suggested they do not pre-date applications before submitting.
Carolyn added, pending CMS approval, there will be a new benefits package
in effect as of August 1.
Sandy said they know there are currently 44,000 OHP Standard clients.
Carolyn explained she thought the benefits for college students may stay
the same. Ellen said OHAC was
supportive of the reduction by income level because they didn’t want to see
people at higher income levels receive benefits while the most vulnerable are
dropped off. She added if the
premium sponsorships continue, people living under 10% FPL will hopefully remain
enrolled.
Sandy explained the State will be doing a direct mail next week to notify
clients of the upcoming changes to OHP Standard.
Carolyn added they will be going to the E-Board in September or November
to address the premium program. They
have not decided when the FPL will change to either 50% or 30% and she
anticipates the decision taking place between August and October.
Ellen pointed out the Legislature can make a decision on simplifying the
premium program regarding where they can be paid.
She asked Carolyn about the status of the cognitive disability situation
after July 1. Carolyn said she has
a staff member, Michelle Marks, totally focused on processing the applications
by June 30. She added they need
name, social security number, phone number and disability on the letters.
She added July 1 is not the drop dead date, but they want the
applications as soon as possible. Joyce
Clarkson added it is up to the workers to follow-up on looking into OHP Plus
eligibility for these clients. She
added there’s no lapse in coverage for these clients.
There was additional discussion on the significance of filing for hearing
requests. Ellen pointed out that to
continue benefits without getting dropped, the client must file for a hearing
request within 10 days. Carolyn
stressed the importance of including the social security number.
Jennie encouraged everyone to enroll as many people as they can before
June 30.
Ellen ran through the chronology of upcoming activities: Next week – standard clients receive notice; June 20 –
co-pays eliminated; June 30 – last day of request for OHP application; August
1 – OHP Standard benefits increase.
Kelly Harms explained the process for applying for FHIAP. She told the group they will be doing more aggressive
outreach as they are budgeted to cover 15,000 and have not reached that to date.
She added they currently have 12,000 on the waiting list for the
individual market. She will get a
breakout to Ellen on the FPL of clients covered under the group market.
III. Legal requirements for determining eligibility for Plus before disenrollment from Standard– Sandy said she would invite Nancy Talbot to the next EAC meeting to explain what SPD is doing. Jennie asked to have a list of programs available to clients other than OHP Standard for the next meeting. Carolyn explained Joyce is currently working on distinguishing between OHP Standard, TANF, MAA, and MAO eligibilities. Sandy encouraged everyone to teach their outreach workers to avoid doing eligibility determinations and error on the side of filling the application out. Ellen pointed out the Oregon Law Center suggested that before eliminating a client from OHP Standard, the State must determine eligibility for OHP Plus. Joyce said they are looking at everybody for every program. Sandy asked for clarification from Ellen that she wished to understand the connection between programs, who was doing what, and how they relate to each other. She will bring this information to the June meeting. Rhonda asked if there was a limit to clients that can enroll in OHP Plus. Carolyn explained there was no limitation. It was suggested that the policy issues and how they are communicated down to the outreach workers be addressed at the June meeting.
IV. Hospitals/communities stepping up to the plate to support OHP premiums – what you can do to get your community involved – Ellen told the group the premium assistance committee has gone through extensive discussions and some major changes have taken plan. A few weeks ago, OMAP had informed them they could no longer support premium sponsorship, then, within 10 days, they changed their minds. Multnomah County was able to support premiums for everyone in the county and other counties (Lane, Lincoln, Wallowa, Benton, Marion, Polk, Linn, and Union) paid premiums on behalf of their clients. She addressed the letter to William Earhart and the numbers of individuals who were covered.
Liz Baxter addressed a six-month summary she had done for Legacy about what has transpired relative to premium sponsorships. She explained the effort started in October with a group of stakeholders pulling together with a deadline of January 1, 2004 to create a model to work from. The concerns included (1) if a provider, money paid violated anti-kickback laws (gaining benefit by keeping clients enrolled); and (2) any money OMAP received from a provider was accounted for as a provider-related donation. Under many circumstances, provider-related donations are not eligible for federal match. OMAP gave the group some time beyond January to come up with a model to alleviate the concerns they had. One solution was to have a charitable organization, Community Health Partnership (CHP), act as financial sponsor, receiving donations and paying the premiums. This model was finalized at the end of March. One of OMAP’s concerns was that if they were going to support a model, it had to provide for statewide equal access, and the group was uncertain they could do that. OMAP had said the premium support would stop at the end of April, then after efforts by advocates, OMAP reversed their decision around the first of May. In the meantime, CHP had walked away so the group has been spending the last few weeks trying to put the model back together.
Liz further explained that individuals have until the 20th of the month to get their premiums and sponsors have until the 11th or 12th. As of June 1, providers will no longer be permitted to pay premiums on behalf of enrollees. OHAP was permitted to pay premiums in May and CHP can pay premiums in June. She explained for an organization to pay premiums, they must prove that the organization does not get over 25% of its revenue from providers. She added OMAP would like to get out of the business of identifying enrollees for the group so the group is currently trying to figure how to secure the number of enrollees without having to go through OMAP. This many be done by having small community agencies taking up the task of being the place where enrollees can go for help with premiums. The new model needs to be in place by this Fall because the agreement with OMAP giving numbers is not permanent.
Rhonda asked if clients are notified their premiums have been paid on their behalf. Liz said within the last 14-15 months, they have not and there has been confusion with people receiving notice they have been disenrolled and still receiving their medical cards. She added that part of this transition is determining how to notify people on what’s been going on. Marcie expressed her concern that William Earhart has been sending out disenrollment notices before the deadline for premium receipt. The group discussed the concern over how many notices are going out to clients regarding premium deadlines, July 1 cut-off, etc., and it would behoove EAC members to get the message out that clients on what’s going on and what they need to do.
Ellen told the group that April premiums were paid for clients in Linn, Lincoln, Lane, Benton, Wallowa, Union, Marion and Polk Counties, so no clients should be disenrolled. She stressed that other communities would be willing to pay premiums if they had the information on their option to do this, and it’s important to get this information out to them on their ability to do this and where to send the check. She added if Multnomah County received a notice before the 10th of the month and pays the premiums, no one should receive a notice they were disenrolled. Liz explained that notices go out from a number of agencies: CAF, OMAP and William Earhart. She added they may be able to flag the counties that are paying premiums so this doesn’t continue to happen.
Glenna explained that hospitals in Wallowa County would like to continue paying premiums, but they need documentation in place. Ellen pointed out there is no accountability from William Earhart and they should be able to account for the premiums received. Liz explained the information may come from OMAP. She added in March Kevin Earls took a proposal to the Oregon Association of Hospitals & Health Systems (OAHHS) board to have hospitals donate to a premium fund until the first of August. It was approved unanimously, however the State didn’t approve the model so this was not pursued. OAHHS may be the entity going to the hospitals statewide to tell them what they can do to help with premiums.
Ellen addressed the dynamics of having a number of hospitals in each county and how they can divide up contributions between them to cover premiums. She added managed care plans can also help She questioned the legal constraints relative to statewideness. Liz explained it is an equal access piece, and the current model is just a patch, an inefficient, ineffective way to help people right before they get dropped. She further explained the April premiums keep clients eligible for the month of June. In Multnomah County, Legacy, Providence, OHSU, Outside In and many others paid premiums through CHP so some premiums were paid twice. She explained the list was run on the 10th and the deadline was the 20th, so it was very likely that many people may have paid their premiums between these dates. She explained the group has asked that Earhart either credit duplicated payments to the following month or refund the money, however, they have not responded to Ellen’s and Mary Lou Hennrich’s letters. She understands they are making every attempt to do what’s been asked of them. She explained that OHAP and CHP may have cut checks that were 30% more than what was needed.
Liz stated there has not been a way to get the word out to community agencies. Discussion pursued. She explained that the money that got used in May was money Multnomah County had set aside for May, June and July. The only way this is going to happen again in June is if money comes from other sources. In June, Multnomah County will not have any money since they paid for all of Multnomah County in May. She further explained that for every other person who paid their own premiums, they will be posted first, and the check from CHP will be posted last, covering the balance of those who would have been disqualified. At this time, the group is waiting to hear what the balance is from the checks cut by OHAP and CHP.
Ellen recommended getting communities involved with the premium payments because Multnomah County Health Department can no longer legally pay premiums. They need to get the answers to the questions sent to Earhart to better inform the community groups so they don’t blindly send in money. Liz stressed the need to determine how they get the information out to bring people to the table. Ellen suggested crafting a letter to go out through OPCA and OAHHS to all clinics and hospitals, encouraging them to work internally with their communities and collaborate. Liz stressed the need to contact the locations where enrollees go, including the small clinics. Michele suggested pursuing community action agencies. Laura suggested approaching grassroots non-profit organizations and letting them know there is a premium sponsor in their area they can contribute to. Kelly added there are approximately 7,200 providers in the Oregon Medical Association who can be contacted.
Ellen recommended they set in place a process for communities to pay premiums. Liz pointed out there are organizations paying premiums and they need to know who they are so they can coordinate efforts. She stressed the need to have a premium sponsor in every community, letting organizations know where they can donate funds. Ellen recommended they schedule another premium sponsorship meeting and passed around a sign up sheet for anyone in EAC who’s interested in attending to sign. Jennie will send out an email next week, informing people on the next sponsorship meeting. Ellen expressed her concern about the meeting time and the fact that the numbers will be run on the 6th. Liz pointed out the fundraising will have to be based on last month’s numbers. She added the draft policy model should come out in the next week. She will try to get the numbers broken down by county on what was paid for how many since the communities need to know if their enrollees are being covered by their contributions.
Ellen pointed out the hospitals want to pay the premiums, so they don’t need to ask smaller organizations for help. Laura suggested that businesses that don’t have insurance may be receptive to helping with premiums. Ellen stressed that until they get answers from Earhart and OMAP, they should only approach the big players.
V. Revising OHP applications – an update - Sandy told the group there were six people from the State and six from EAC who had participated in an OHP application meeting on November 10, 2003. They rewrote some questions to make them easier to understand, however didn’t do anything with it because they wanted to wait and see what happened with Measure 30 and the OHP Standard population. In the meantime, a group of DHS people got together to look at a revised application (415F) CAF has been using. The question now is whether they want to pursue a revised OHP application or one application that screens for all programs. No decisions have been made to date and they will be reconvening the OHP application group to review the two applications. From there, they wish to see what applicants think of the applications. She is currently writing an issue paper now, which should be complete in the next week, and the group will probably reconvene in the next couple weeks.
VI. Announcements & Adjournment
A. Next
meeting: June 22, 10:00-12:00
p.m., DHS Parkway Bldg., Upstairs, Room 6
Note: Limited
parking; overflow at Fred Meyer across the street
B. Adjournment:
12:00 p.m.
Handouts:
OMAP Medically Eligibles Data (April 2004) OHAP letter to William Earhart
OHP Standard Medically Eligibles Data (April 2004) Premium Delinquency letters
April 2004 EAC minutes OHS Health Care Policy Summit flyer
OPCA Enrollment postcards DHS Quarterly Report (Jan-Mar 2004)
OHP Application Checklist Refined OHP Standard Benefit Package flyer
ENROLL NOW flyer
EAC Minutes-052504.doc Recorded by LoriAnn Sheridan, OHAP