But OHA estimates 25 percent of open card members could be enrolled in a CCO, though Hayden believes it could be as high as 100,000.
In addition to speeding the process, House Bill 2979 also removes some exemptions, which will also help boost CCO membership. OHA is already changing the enrollment process to assign dual eligibles to a CCO, unless they opt out, as well as those with other medical coverage, such as veterans.
OHA wants as many “open card” members as possible to join CCOs, which are designed to connect them with primary preventive care. The CCOs have saved federal and state taxpayers $1.3 billion since 2012, said OHA spokesman Robb Cowie.
“It is one of OHA’s top priorities to enroll Oregon Health Plan members in the CCOs,” Cowie said.
The drop-off in CCO members stems from a delay in re-determining their eligibility. OHA has completed about 700,000 Medicaid redeterminations, which are required annually. But it is still working through the remaining 115,000. Gov. Kate Brown set an Aug. 31 deadline to complete that work.
The delay goes back to Cover Oregon, which was the state’s one-stop-shopping site for private health insurance plans and Medicaid. But Cover Oregon failed to launch properly, spawning numerous lawsuits between the state and its contractor Oracle America that were settled last year.
Meanwhile, OHA switched to a new online enrollment platform. It obtained a federal waiver to suspend renewals while it transitioned to the new ONE Eligibility system, as the data from Cover Oregon was inaccurate, Cowie said.
“We needed to go through a process where we could stand up ONE, and then once it was up and running, manually enter in data for each OHP member,” Cowie said.
OHA resumed the renewal process in 2016 and has since been working through renewals. But a portion of members have been slow to respond and fallen off the program. They may come back onto open card, but not immediately into a CCO.
“This is all part of the Medicaid cleanup process,” Cowie said. “We’re hopeful that once we complete the renewals by Aug. 31 and everyone is in the ONE system, we’ll see CCO membership rebound and we won’t have a temporary and artificial dynamic occurring.”
Hayden said the agency’s cumbersome 32-page paper form has been a big obstacle to many members. Once someone is in ONE, though, they can renew online, which is a much simpler process, Cowie said.
The redetermination snafus also caught the attention of Secretary of State Dennis Richardson. He issued an “audit alert” last month saying OHA “spends millions providing benefits for ineligible recipients,” with as many as 86,000 current recipients who may not be eligible.
OHA officials estimate about 32,000 out of the 115,000 whose renewals they are still processing will no longer be eligible, based on historical trends. But anyone currently enrolled is considered eligible until their redetermination is complete.
Another audit from Richardson found that while OHA’s IT system is now performing well, the state needs to improve the accuracy of its manual inputs.
Over time, responsibility for renewals will be shifted to the Department of Human Services as part of the state’s plan to centralize and streamline the benefit eligibility process and make it simpler for clients to navigate, Cowie said.
After passing unanimously out of the House Health Care Committee, HB 2979 is pending in Ways and Means.
Elizabeth covers health care for the Portland Business Journal. Sign up for her free email to keep tabs on the rapidly changing industry.