[DHS-Stakeholders] News Release: Standard to close to new enrollees

[JOYCE Lisa R]

Health Plan's Standard benefit package closes to new enrollments July 1

Contact: Jim Sellers (503) 945-5738
Program contact: Cindy Becker (503) 945-5944

The Oregon Health Plan's Standard benefit package will be closed to new
enrollment beginning July 1, as officials begin to scale back the plan in
response to budget limitations.

The Standard plan currently covers about 50,000 Oregonians. This figure must
be reduced by more than half by June 30, 2005, to be sustainable with
available dollars, according to the Oregon Department of Human Services (DHS).

In addition to the suspension of new enrollments, reaching this goal will
likely require stricter income eligibility requirements as plan participants
reach the end of their six-month enrollment periods and reapply.

State general-fund dollars are being withdrawn from the Standard plan under a
budget-balancing plan that the legislative Emergency Board approved in April,
in response to the Feb. 3 defeat of Measure 30.

 "I am pleased with the cooperation we are getting from the federal government
and from our partners who deliver benefits through the Oregon Health Plan,"
DHS Director Gary Weeks said. "This teamwork should permit us to provide a
high level of service to those whom the Standard benefit package continues to
cover."

The 2003 Legislature approved two taxes -- one on Medicaid managed care plans
and one on hospitals -- to help fund the Standard plan.

The managed care tax has received the required approval from the federal
Centers for Medicare and Medicaid Services; a request for approval of the
hospital tax is pending. Each dollar from the taxes will be matched with $1.50
in federal Medicaid money to fund the Standard plan. However, these revenues
will not fund the plan at its current level.

Notices of the closure to new enrollments are being mailed today to people
currently on the Standard plan -- low-income adults who don't qualify for
traditional Medicaid.

"We are advising people already on the Standard plan that for now, they can
keep their eligibility by paying their premiums on time, and by reapplying
timely when they are notified that their six-month eligibility is about to
end," said Lynn Read, state Medicaid director for DHS. "We will provide
additional notice to participants if we need to make changes in Standard
eligibility."

Department officials are still reviewing projections to determine what changes
to eligibility may be necessary to reduce the plan's expenses to a sustainable
level.
Currently, participants must have an income below 100 percent of the federal
poverty level, or $1,041 a month for a family of two.

Pending the necessary federal approvals, it is anticipated that the remaining
covered population would receive a benefit package covering doctor visits,
prescription drugs, outpatient mental-health and chemical-dependency
treatment, emergency dental, lab, x-ray, medical supplies and a limited
hospital benefit.

The nearly 300,000 people covered by the Health Plan's Plus package are
entitled to coverage under federal Medicaid law and aren't affected by the
changes. The Plus package is available to foster children and to people who
are aged, blind, disabled or on public assistance.
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