For the first time since mid-2004, the Oregon Health Plan is preparing to accept new enrollees for its Standard benefit package.
The Standard benefit package serves low-income Oregon adults ages 19 to 65 who do not qualify for traditional Medicaid but earn less than the federal poverty level ($20,650 annually for a family of four).
Beginning Jan. 28 and lasting through Feb. 29, Oregonians who believe they might qualify for OHP-Standard may put their names on a reservation list by calling a 60-line phone bank, sending an e-mail or using U.S. Mail. Shortly after Feb. 29 the Oregon Department of Human Services will begin drawing names from the reservation list, using recognized random-selection methods. DHS then will send individuals whose names are drawn applications for OHP-Standard. Those applications must be completed and returned to DHS within 30 days.
At its peak OHP-Standard served 132,000 people, according to Jim Edge, state Medicaid director in the Oregon Department of Human Services. However, due to General Fund budget cuts in 2004, the program was closed to new enrollments and the number of clients served was reduced to an average of just 24,000 a biennium.
The program now is supported by taxes on hospitals and managed-care plans, which the two industry groups supported. Attrition has dropped the numbers of people served to 19,000, opening the way to enroll more individuals until the biennial average of 24,000 clients is reached.
"We believe demand will be high for this health care coverage," said Edge. "Many more people qualify than the number of openings available, which is why we have created the reservation list and random selection method. We believe this is the most equitable way to enroll new clients."
People wishing to get on the reservation list beginning Jan. 28 may:
• Go to www.oregon.gov/DHS/open and select "Request Form" from the menu option, then complete and submit the form.
• Pick up a form at a DHS office, complete it and return it to any local DHS office, or fax it to 503-373-7866 or 503-378-6925.
• Call 1-800-699-9075 toll-free Monday through Friday between 7 a.m. and 7 p.m., Pacific time. Salem-area residents may call 503-378-2666. The call will take 10-20 minutes to complete.
• E-mail the required information to firstname.lastname@example.org.
• Mail the required information to Oregon Health Plan, P.O. Box 14520, Salem, OR 97309-5044.
Individuals must provide their full name, date of birth and mailing address.
A person may put another individual's name on the reservation list if the individual's full name, birth date and mailing address are known. No reservations will be accepted prior to Jan. 28.
Edge noted that DHS is launching a vigorous statewide information campaign to reach as many Oregonians as possible with news about the reopening of OHP-Standard.
"We are inviting nearly 2,000 partners and providers to help us get the word out," he said. "We're working with education service districts, low-income health care clinics, county health departments, hospitals, tribal offices, legal aid organizations, faith organizations, advocates and others. We want as many people to know about this opportunity as possible."
Among OHP-Standard's benefits are physician services, prescription drugs, chemical dependency and mental health services, emergency medical services, and limited dental, hospital and vision benefits. Most enrollees pay modest premiums.
The federal government approved use of the reservation system as part of its authorization to the state to continue the Oregon Health Plan, whose budget is 60 percent federally supported, for another three years.
The OHP-Standard benefit package is a key element of the 13-year-old Oregon Health Plan. It expands health care coverage to impoverished adults who do not qualify for traditional Medicaid coverage. Children and adolescents may receive coverage if they live in households with incomes up to 185 percent of the federal poverty level even if adults in the household are ineligible.
Edge also noted that other Oregon Health Plan benefit packages continue to be open to new enrollees.
"I encourage people who do not have health care insurance to not only get their names on the OHP-Standard reservation list during February," he said, "but also to see whether they may qualify for other Oregon Health Plan coverage."