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Oregon pioneers continuous Medicaid coverage for kids through their 6th birthday

In this file photo from 2017, a young girl receives a flu vaccine. Oregon is the first state in the nation that will allow kids with Medicaid coverage to remain continuously enrolled through their 6th birthday.
Courtesy of the Centers for Disease Control and Prevention
In this file photo from 2017, a young girl receives a flu vaccine. Oregon is the first state in the nation that will allow kids with Medicaid coverage to remain continuously enrolled through their 6th birthday.

Oregon will roll out a number of first in the nation changes to its Medicaid program over the next five years. Top among them: continuous coverage for kids through their 6th birthday and spending on food and housing for certain in-transition populations.

Oregon is the first state in the nation that will allow kids with Medicaid coverage to remain continuously enrolled through their 6th birthday.

This means low-income families won’t have to re-enroll every year to keep their kids insured.

Gov. Kate Brown made the announcement Wednesday, alongside federal officials from the Centers for Medicare & Medicaid Services.

“Keeping young people continuously enrolled in Medicaid up to the age of 6, to prevent gaps in coverage, regardless of changes in their financial circumstances is a paradigm shift,” Brown said.

More than 1 in 3 children in Oregon is covered by the Oregon Health Plan.

In another change, Oregon and Massachusetts will become the first states to use the federal health insurance program to fund rental assistance and food aid to some state health plan enrollees who qualify.

In Oregon’s case, the state will receive a major infusion of new federal funding for housing and food assistance: $1.1 billion over the five years the program is in effect. Oregon will be required to contribute $88 million of state funding in the final year of the program.

Oregon’s new Medicaid spending on so-called “health-related social needs” will also include a program targeting the health impacts of climate emergencies.

Oregon Health Plan enrollees who have a demonstrated medical need can qualify for a benefit that will directly cover the cost of things like air conditioners, air filters, or temporary shelter during wildfires or other declared emergencies.

Oregon Health Plan state applied for and received the changes through a five-year waiver process.

The federal government allows states to use the waivers to bend the typical rules that govern Medicaid. The waivers encourage innovation and are supposed to be cost-neutral.

Joan Alker, with the Georgetown University Health Policy Institute, a non-partisan research center, has long advocated for continuous coverage for children.

“In the United States, when you turn 65, everyone knows you’re going to get Medicare. That’s not true when you have a baby,” she said. “I think Oregon’s approach moves us one day closer to a day when that vision is realized, a day when no baby leaves the hospital without health insurance.”

Nationally, between 5 and 6 percent of kids don’t have health insurance. Experts say the annual re-enrollment process is a major reason for that gap in children’s coverage. Some families may never get the required paperwork in the mail or struggle to complete it, particularly if they move frequently or have limited proficiency in English.

Eliminating gaps in children’s coverage also provides better economic security to families, Alker said.

“Even getting one large medical bill — a child falls on the playground, breaks a bone, has to go to the emergency room — that can be enormous medical debt,” said Alker.

Washington, New Mexico, and California are considering similar proposals to make children eligible for more continuous Medicaid coverage.

In Oregon, the shift toward more continuous enrollment isn’t limited to the youngest children. Children 6 and up and adults on Medicaid will be able to stay enrolled for two years at a time.

Medicaid eligibility checks have been suspended during the COVID-19 pandemic, but they will resume when the federal government’s declaration of emergency expires — a date yet to be announced.

That’s when Oregon’s new enrollment policies are expected to kick in.

The policies will reduce the number of people kicked off Medicaid and add to the number of enrollees, increasing the costs of the program. The cost over the next five years, according to the Oregon Health Authority, will be $850 million in federal dollars and $409 million in state dollars.

Akler says investments in young children’s health care pay off for societies in the very long term.

Not all Oregon Health Plan enrollees will qualify for housing and food aid. The program is designed to support the health of Medicaid enrollees “in transition,” a group that includes youth in foster care, people who are homeless or at risk of homelessness, and low-income older adults, according to OHA.

Rent assistance through Medicaid will be available for up to six months. Other services could last longer.

Mercedes Elizalde is the policy director at Central City Concern, a social service and health care organization that serves people who are homeless and in treatment for substance use disorder.

Currently, she says, some of Central City Concern’s clients in treatment for substance use disorder don’t have any access to housing assistance — a situation that makes them more likely to not complete treatment.

“This announcement today is the first step to putting that kind of inhumane inefficiency in the rear-view mirror,” she said.

The program will also fund food aid for the “in transition” groups, including food boxes, and prescriptions for vegetables and fruit.

Enrollment in the new food and housing benefits will start in 2024, according to OHA.

Copyright 2022 Oregon Public Broadcasting. To see more, visit Oregon Public Broadcasting.

Amelia Templeton is a multimedia reporter and producer for Oregon Public Broadcasting, covering Portland city hall, justice and local news. She was previously a reporter for EarthFix, an award-winning public media project covering the environment in the Northwest.