OREGON HEALTH ACCESS PROJECT

Expanded Access Coalition Meeting

December 14, 2004, 10:00-12:00 p.m., OHAC

MINUTES

Attending:

Linda Herman (Clackamas County Health Dept)                Barney Speight (OMAP)

Sandy Wood (OMAP)                                                         Nancy Horn (OMAP)

Ellen Pinney (OHAP)                                                           Marcy Sugarman (MCHD)

LoriAnn Sheridan (OHAP-CKF)                          Lynn-Marie Crider (SEIU/OHAC)

Carol Simila (OR Insurance Division)                                   Michele Wallace (DHS-CAF)

Gary Cobb (Recovery Assn. Project)                                    Jo St.Clair (OHSU)

Nicole Shuba (IPGB/FHIAP)                                               Cindy Bowman (IPGB/FHIAP)

Jason Hardaway (Wellpartner)                                        Alberto Moreno (Migrant Health-DHS)

Jerae Belland (Marion County Health Dept)                Jennie Hamilton (OPCA)

Raeann Reese (OMAP)                                                         Katie Gauthier (Oregonians for Health Security)

Tom Holser (OHAC Eugene)                                               Bill Norris (OPCA)

MaryAnn Holser (OHAC Lane Cnty)                            Lindsay Couch (LCDCFH)

Karen Berkowitz (Oregon Law Center)

I.          Call To Order & Introductions – Ellen Pinney called the meeting to order, giving a brief background on Covering Kids & Families (CKF).  Introductions followed.   

II.            Enrollment Numbers -  Nancy Horn handed out the October Medically Eligibles Data.  Nicole Shuba and Cindy Bowman of IPGB/FHIAP gave an update on the FHIAP enrollments, which are currently at 7,975.  Jennie Hamilton asked about barriers to enrolling in FHIAP due to the fact their enrollment numbers are so low.  Marcie Sugarman expressed her concerns about the out-of-pocket expenses being too high for FHIAP for some clients.  There was a brief discussion on the enrollment process, premium subsidy program and barriers.  It was pointed out that premiums are taken out of employees’ paychecks up front for those covered in the group plan and people on the individual coverage are billed. 

LoriAnn Sheridan commended FHIAP on their proactive outreach, getting the new brochures out, especially in Lincoln County. She asked about community workers’ ability to distribute and assist with FHIAP applications.  Rhonda Walker, the Lincoln County CKF Coordinator,  told her that a client was told by someone at FHIAP that Rhonda was not allowed to do this as FHIAP assigns a number to the application.  FHIAP staff said they would check into this, but it was their understanding this was permissible.  Tim Miller asked if FHIAP was willing the pay non-profits for marketing their program to families.  Nicole said they are currently hiring more enrollment specialists at this time.  She added the applications they distribute have the reservation numbers on them.  Nancy said the OHP packets include information about FHIAP.  Michele Wallace added the new OHP 7210 applications were out for distribution on November 1.  Ellen pointed out that most applications are being processed out in the field now rather than at OHP Central.

Ellen shared what she learned at the Outreach Workers meeting regarding enrolling in FHIAP – if dropping from OHP Standard and moving immediately to FHIAP, there are no pre-existing conditions delay when they get private insurance.   However, if their insurance lapses for more than 63 days, the pre-existing condition clause applies.  Time is critical given FHIAP’s double application process.

III.       OHP Standard Premiums – Ellen addressed the low attrition of people paying $6 premiums, adding the premium workgroup is currently working with a model of “anonymous benevolence,” but wants to move to a more proactive client-engaged model.  She asked that if anyone hears of clients at the $6 premium level getting dropped by Earhart, to let her know with specific names so the problem can be addressed.  She added that Union Gospel Mission has been serving as a conduit for one large check to Earhart for a statewide pool covering all ODQ’s at $6.00 or less.

                        Jennie addressed Earhart’s accountability.  Marcie pointed out clients can pay one month at a time or for six months coverage.  There is some ambiguity around whether or not clients may pay in advance or not.  Ellen added she was uncertain how long the Oregon Association of Hospitals & Health Systems will cover the $6 premiums.  She also shared her concern that Earhart is receiving $3.11 for each premium collected and there may be an audit.  She said OHAC is currently trying to get enough information for the Secretary of State’s office to warrant the audit.  She pointed out there are many mixed messages from Earhart, as OHAP submits premium payments well above the required amounts and Earhart lets OHAP know what is available in the account the following month, however, others are getting dropped when payments have been made. 

IV.       EAC Meeting Times – Ellen asked those attending whether or not they wished to change the times of the monthly meeting.  Everyone indicated they were satisfied with meeting the fourth Tuesday of the month, 10-12 p.m. at OHAC.

V.        EAC Priority Survey – Ellen passed out a survey on EAC priorities, asked that each attendees prioritize them by marking 1-10 with an A & B column (A-if wishes can come true and B-reality).  She asked that the surveys be submitted by the end of the meeting so she may take to the COER meeting following adjournment of EAC to determine next steps for the next two years of CKF.  She explained the three primary components of CKF is outreach, simplification of application process, and coordination between programs.

VI.       Kid Care Update – Nancy told the EAC they are currently finishing up phase one of the project and now analyzing the data.  The draft should be available in the next week to 10 days as they have an obligation to get it to the Governor by the end of the month.  She explained KidCare is the Governor’s initiative started this summer to enroll any many kids as possible in public health care in two pilot counties, Hood River and Lincoln.  In response to questions, she explained the state initiative is an unfunded mandate, and costs are being absorbed by existing OMAP budget and local coalitions.  She added they have discovered a lot of best practices even though the State missed the back-to-school efforts this year, that they can hopefully apply statewide when funding allows. Lincoln County had already planned and engaged the school districts in a successful back-to-school effort before Kid Care was instituted in that county.

                        Carol Simila pointed out that what is missing is a concerted effort on insurance as there are too many piecemeal efforts going on, failing to provide information on other entitlements.  Ellen explained the KidCare was strictly focused on kids and both counties have experienced problems with the initial approach – people in Hood River understood the initiative to be for all kids regardless of citizenship and Lincoln County had issues around retention efforts.  Jason Hardaway briefly addressed the Healthy Kids program in California.  Sandy Wood pointed out they did a lot of research on other states’ efforts, what worked well and didn’t work well.

VII.            Proposed DHS Budget & 2005 Health Policy Options – Barney Speight, OMAP Administrator, gave a brief overview of the Governor’s recommended budget and priorities for 2005-2007.  The Governor’s budget assumes a general fund at $11.9 billion, a 9.3% increase of the previous biennium.  The DHS budget was also increased by 9.2%. with OMAP funding at $774.2 million for medical assistance programs although they requested $943.7 million.  He pointed out there was no funding for trending or inflation.  He reviewed the DHS 2005-2007 Governor’s Recommended Budget report.  If implemented, the Governor’s proposed budget reductions will result in the elimination of dental and vision services, among other programs (general assistance, relative foster care, employment initiative).  In total, 3,000 persons will be eliminated from programs.  He pointed out the state is relying on the provider tax revenue to support 24,200 OHP Standard clients as there are no funds in the general fund to support this.  He added there is $169.5 million in initiatives, which are not included in the Governor’s budget.  He pointed out Erinn Kelley Siel indicated if there are other ways to addressing programs within the budget limitations, the Governor’s office is receptive to looking at them.

                        Barney briefly addressed the three workgroups that will be developed by the Health Policy Commission:  (1) seniors & people with disabilities, (2) administrative efficiencies-DHS work group, and (3) cost drivers.  He explained that representatives from OMAP, organizations, stakeholders, and, hopefully, legislative representatives will be involved in these workgroups.  A report is expected back to the Health Policy Commission in March.  Two other issues strategic to OMAP Barney addressed included the Medicaid Management Information System (MMIS), which needs to be replaced, and the Medicare Modernization Act (MMA) Part D where enrollment begins November 15, 2005.  OMAP will need to re-enroll 50,000 seniors as drug benefits will be shifted from the State to the MMA Part D.  In regards to the MMIS, he stressed the need to limit special projects and prioritizing what needs to be done due to time and personnel constraints.

                        In response to a question on what stakeholders will be involved in the workgroups, Barney explained they will be looking to organizations vested in the issues, however, there will also be time for public comments.  Jennie Hamilton pointed out with the $169.5 million cuts in OHP Plus, 3,000 vulnerable people were dropped and the cuts to seniors with home health services that took place during the last legislative session, she has heard from outreach workers in Washington County indicated over 100 clients have died.  She suggested the workgroups look at new revenue and activating a grassroots effort to inform people before after the fact (e.g., cigarette tax).  Barney suggested a good approach is putting a human face to illustrate the impact of the cuts when addressing the legislature and communicating with the public, the voters.

                        Lynn-Marie Crider asked where the $169.5 million cuts came from, existing programs or something else.  Barney explained the cuts are from initiatives that were not included in the Governor’s budget.  She asked about provider reimbursements.  Barney explained that primarily in fee-for-service, there will be no CPI increases for providers, and, in the managed care side, the assumptions that go into the development of the capitation rates will continue.  Karen Berkowitz asked about the clients being dropped from OHP Standard.  Barney said some many continue benefits through other programs, but they need to look at cost savings and the net effect.  He further addressed the number of people impacted – approximately 9,000.

            Ellen addressed the prospect of the E-Board eliminating the $6 premium.  Barney said he didn’t think the E-Board will take any action, deferring it to the full legislature.  He suggested the advocacy community go back to the fundamentals – the nature of the population being served given where we are with the OHP Standard population and given the nature of the caps that have been put on it.  He briefly addressed the premium collection issue, suggesting there needs to be a very modest cost-sharing mechanism.

            Kristi Jamison shared her concern for the recruitment and retention of providers given the current reimbursement schedule.  Barney said he would like to see some strategies on utilization management and fee-for-service with the idea that the funding falls back into the reimbursement rate.  There was brief discussion on clients on SSI, and the prospect of some clients qualifying for other programs.  Alberto addressed the changes in Oregon’s population, with the increase in the Hispanic population.

            Marcy suggested they get the legislators into the clinics to see, first hand, what is going on.  Ellen commended OPCA on their efforts to encourage legislators to visit clinics.  Barney addressed the perception of OHP in the legislature - that a lot of people who are entitled to coverage are not deserving.  He pointed out this is not the OHP that existed in 1994 and 1996, and the legislature doesn’t see the reality in their communities and don’t see the human side.  He added OMAP is currently working on county profiles.  Carol pointed out Barney, with his vast background, may be the opportunity in this crisis to pull together pieces of the fragmented system.  Barney suggested the need for all to work together to address the crisis.  Sandy added they do have links on the DHS website for county resources.  Ellen pointed out that medical debt is the number one reason for personal bankruptcy. 

VIII.            Announcements & Adjournment

A.     Next meeting:  January 25, 2005, 10:00-12:00 p.m., OHAC offices (3896 Beverly Avenue NE, J-6, off Lancaster in Salem)

B.     Agenda for next meeting:  Michele asked if they wished the representative from TANF to attend to address issues.  All agreed.  Michele will arrange it.

C.  Adjournment:  12:00 p.m.

Handouts:

OMAP Medically Eligibles Data (October 2004)                                   

Enrolling & retaining eligible, uninsured children in OHP and FHIAP survey                         

     November 16, 2004 EAC minutes                                                                 

 EAC Minutes-121404.doc                                                                                                                                             Recorded by LoriAnn Sheridan, OHAP