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Oregon Medicaid Proposal Builds on State’s Success

Through a proposed federal waiver, Oregon is proposing innovative ways to deliver health care to low-income residents through Medicaid.  If the federal Centers for Medicare and Medicaid Services (CMS) approves it, Oregon’s waiver will further improve the state’s successful Medicaid delivery system by making it easier for people with mental health conditions or substance use disorders, and those experiencing homelessness, to get needed health care and other services.

Like many states, Oregon has taken advantage of Medicaid’s flexibility to become a laboratory of innovation.  In 2012, Oregon created Coordinated Care Organizations (CCOs), or community-run partnerships among health plans, health care providers, and community organizations that are responsible for providing all health services for their members.  A recent evaluation found that CCOs have reduced members’ use of the emergency room by 50 percent since 2011 while increasing enrollment in patient-centered primary care homes, which coordinate beneficiaries’ physical and behavioral health care. 

Building on the success of the CCOs, Oregon is proposing several new initiatives to improve care for people with the greatest health needs by coordinating their health care and linking them with needed social services. 

Oregon plans to invest in systems to help a broad range of providers share data and communicate about their patients.  It also plans to support partnerships between health and social service providers serving people with very significant health and other needs — such as those who have multiple chronic conditions or are experiencing homelessness — to help them get appropriate care.

Oregon is proposing other new ways to meet the needs of this vulnerable group, such as by providing short-term housing coupled with health services and care management.  This can prevent further hospitalization for people who are discharged from the hospital and have ongoing health needs but no place to live.

The proposal would also expand care coordination to two groups typically ineligible for Medicaid: recipients of inpatient mental health or substance use services and people in jail or prison awaiting trial.  As these individuals transition out of a hospital, jail, or prison and into the community, care coordination could help them get the ongoing services they need and significantly improve their health outcomes.

Oregon’s plan meets CMS’ criteria for a Medicaid waiver and merits approval.  Other states should take note of opportunities in Medicaid to build innovative models like Oregon’s that increase access to care and improve health.