Marketplace Community Conversations are intended to give the public, providers, insurers, and other interested parties a voice in the shaping of health insurance policy in Oregon. The Health Insurance Marketplace Advisory Committee welcomes input and ideas from policymakers, members of the public, representatives of traditionally marginalized communities, impacted industries, and anyone else who has good ideas or thoughtful feedback to offer.
Please note that while these meetings are being developed, the information below is subject to change.
Oregon Public Option and Usability of Marketplace Plans
When: Jan. 18, 2022 from 10 a.m. to noon
You can watch a recording of the video below.
- In 2019 and again in 2021, the Oregon Legislature has provided the Oregon Health Authority (OHA) with funding to study and plan for the creation of a public option health insurance plan. The
initial report was truncated due to the COVID-19 pandemic and the
follow up report was delivered to the Legislature January 1.
- The initial report considered three potential delivery models for a public option in Oregon:
- Using Care Coordination Organizations (CCOs) that currently serve Medicaid enrollees on the Oregon Health Plan
- Using commercial health insurance carriers that offer plans on the individual health insurance market
- Developing a new, state-sponsored health plan using the infrastructure of Oregon's public employee health plans
2021 Implementation Plan proposes that Oregon create a public option plan based on the Coordinated Care Model (CCM) at the heart of the Oregon Health Plan, Oregon's Medicaid program. The plan or plans created would be sold through the Oregon Health Insurance Marketplace (by entities licensed to do so) and thus enable the use of federal premium tax credits that offset the monthly premiums for most people purchasing plans.
- A key goal in the design and development of the plan is to further the state's goal to eliminate health inequities by 2030. Meeting this goal should entail equity-driven plan design that increases access to care and improves health outcomes for communities who face health inequities at disproportionate rates. In addition, outreach efforts should focus on reaching people without health coverage and should be performed in a culturally- and linguistically- appropriate manner.
- The plan should be aligned with efforts of the Oregon Health Plan and Oregon's public employee health plans to increase use of value-based payment arrangements and to improve quality. High-value services should be prioritized, and plans should be encouraged to find creative ways to invest to improve the health of plan enrollees.
- To the extent possible, the state should consider ways to better align provider networks in public option plans with provider networks serving CCO enrollees in the Oregon Health Plan. Increasing alignment of providers and the benefit structure of plans would make it easier when people move between CCOs and private health insurance coverage and improve continuity of care.
- The state may also consider potential statutory changes and federal waiver opportunities that could generate federal pass-through savings that could be reinvested to reduce enrollee costs and/or expand benefits. Examples could include reducing cost-sharing for target income groups, creating a dental benefit for public option enrollees, and additional assistance toward the cost of monthly premiums.
Medicaid Migration to the Marketplace
When: Jan. 20, 2022 from 10 a.m. to noon
You can watch a recording of the meeting below (note: recording skips first part of meeting, please see slide deck).
- In response to the COVID-19 pandemic and the federal requirements around the Public Health Emergency (PHE) declaration, the Oregon Health Plan (OHP) has continuously covered enrollees by holding redeterminations of eligibility. This means, upon submitting a change to income, an over-income or otherwise no longer eligible (NLE) OHP member will not be disenrolled from OHP benefits. Consequently, as many as 300,000 members may be NLE for OHP after the end of the PHE. It is likely that a significant number of NLE OHP members will be eligible for financial assistance to purchase a health plan through the Marketplace.
- Tailor an outreach and marketing campaign designed to offer the best transitional experience for NLE members, including member level outreach to (1) identify the plan with the closest provider network to their current Coordinated Care Organization (CCO) network; and (2) the lowest price plan (with or without subsidies) based on consumer income.