Status of Oregon Health Plan Multnomah County April 2004

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Status of Oregon Health PlanMultnomah
CountyApril 2004

• Desired Outcome At the end of the briefing an
  increased understanding of
• Oregon Health Plan (OHP) History
• Current Status of OHP - System wide, Regionally
  and Locally
• The Future of OHP - Potential Scenarios, Changes
  and Remedies

Lillian Shirley, MCHD Dave Ford, CareOregon
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Medicaid

• 1965 Federal Law
• Medicaid Provide for the most vulnerable
• Medicare Improve care access for elderly
• Covered 9.1 of Population in 1978
• Covered 12 of Population in 1998
• Joint Federal and State Program
• Eligibility based on income and need category

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In Oregon
Oregon .37
Federal .63
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Coverage

• 32 Million Nationally
• 430,000 in Oregon
• Not all low income people
• States decide groups
• Financial criteria
• For Oregon to receive Federal Funds
• Meet categorical Criteria
• Or, have a waiver

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People Enrolled by Eligibility

• Mothers and Children
• Blind and Disabled
• SSI Social Security
• Pregnant Women
• Medicare
• Without Medicare
• With Medicaid

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Very Real for Oregon
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Choices facing Legislatorsin 1990

• Cut enrollment despite increased Need
• Pay providers less Doctors, Hospitals less
• Develop a method for better Purchasing
• Rationing
• Managing Reducing wasteful practices

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Oregon Legislative Decision 90s

• We want to cover all vulnerable in Oregon
• We want to Pay only for necessary care
• Which is important for life or will actually cure
  people
• Which is fairly set by experts and the community
• We want to manage the efficiency of the care
  delivered to enrollees
• We want the Federal Government to help pay for
  this

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• The Oregon Health Plan
• As designed
• Consensus about Priorities of benefits
• Set by experts and community
• Apply for Federal Waiver
• Extended coverage to
• Employers
• People not now qualified for Medicaid
• 150-200 of Federal Poverty level
• Called OREGON STANDARD
• Washington agrees to pay .63
• per Oregon Dollar spent

A Great Vision
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So What Happened

• Oregon Expanded Coverage to 100,000 more people
• The Delivery System expanded capacity
• Counties and Safety Net
• New paying clients instead of free care
• Mental Health, Chemical Dependency, Physical
  Medicine
• New organizations to Manage Care
• CareOregon Founded by Multnomah, SNC, OHSU

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Current Status
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Measure30 Vote

• 911
• National Recession
• Job losses
• State Revenue Down

2002 E-Board 2003 Legislature
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(No Transcript)
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National Criminal Justice/MentalHealth
Consortium Study1999

• Many Untreated end up in CJS
• Mentally Ill
• Chemically Dependent
• Jails are full and expensive
• Study in Marion County, Oregon 40 bankruptcies
  due to insurmountable health costs

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1.1 Million
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If Standard Goes Away, Who Pays
Charges With Coverage
GF
Medicaid Payment For Standard
Federal Dollars
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(No Transcript)
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Oregon Average Health BenefitPer Employee
7500 7000 6500 6000 5700
Will this Help Oregon's Job Recovery?
2003
2003
2003
Dollars
2002
2002
2002
National West
ORSW Washington
Regions
Source Mercer 2004
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Safety Net Infrastructure ShrinkageFrom Loss of
OHP Standard

• Out Patient CD
• Multnomah County
• Potentially Loss of County Clinic Sites
• PCP Access Reduced
• ER up
• Real jobs lost in recovering economy

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The Future OHP Potential
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Managed Care and Hospital Taxto Support OHP
Standard
Federally Approved
Net Combined Tax 39.7 MM
Pending Approval
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(No Transcript)
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Plan
Current Level
New Reset Program
Standard Stable _at_ Approx. 23,000
2004 2005
Next Decade
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Impact Multnomah County Who We ServeFY 04
Compared to 05
Primary Care Medical Visits First 7 months of
FY2003
Primary Care Medical Visits First 7 months of
FY2004
Self-Pay Uninsured 26
Self-Pay Uninsured 33
Medicaid/OHP Plus 44
Medicaid/OHP Plus 71
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Impact of Oregon Health Plan Changes To Date on
MCHD
Primary Care Visits Budget to Actual FY04
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Revenues Decline while Service Demand Rises
Visit Trend Compared to CGF and Medicaid Funding
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MCHD Response to Changes in OHP Reconfiguration
of Clinical Services
GOALS

• Customers
• Finance
• Processes
• Employees