Oregon health leaders warn of bumpy start for expanded Medicaid system 

By BEN BOTKIN/Oregon Capital Chronicle

SALEM — Oregon’s Medicaid system, which covers more than one in three Oregonians, faces a monumental challenge: proving that its expansion will help keep people housed, fed and healthy.

Oregon’s new Medicaid plan will put more than an additional $1 billion into the system, in part to help people with housing assistance, food and address climate-related needs like air conditioners. The plan also will keep children under 6 enrolled while focusing on helping the most vulnerable Oregonians.

It’s an historic change for the Oregon Health Plan, the state’s Medicaid program that has traditionally focused on providing medical, dental and behavioral health care coverage to low-income Oregonians.

But nutrition, housing and living accommodations also affect long-term health, prompting Oregon officials to apply to the Centers for Medicare and Medicaid Services for permission to launch an expansion

“This is a demonstration,” said Dana Hittle, Oregon’s Medicaid director, at a panel discussion on Thursday at a health care conference in Salem. “We’re going to make mistakes and hopefully there’s some grace at the federal level. We’re learning.”

Hittle spoke in a panel about the new program at CCO Oregon’s annual conference in Salem, attended by 350 people. CCO Oregon, a nonprofit, has members that include health care companies, advocates and coordinated care organizations, the state’s regionally based Medicaid insurers.

The panel also featured: Marin Arreola, a member of the Governor’s Racial Justice Council; Sarah Holland, director of supportive housing and employment services at Central City Concern in Portland; and Melanie Westrick, vice president of population health and clinical operations at Trillium Community Health Plan, a coordinated care organization with about 87,000 people in the Portland area and Lane County.

Central City Concern helps homeless people find housing, employment and health care. Holland said the organization works with people to develop a long-term employment plan while they receive the six months of housing so they don’t return to the streets.

“The reason that we offer health care, employment services and housing is we believe that most people actually need all three to not only secure housing, but maintain housing,” Holland said.

Hittle agreed.

“The six-month rental assistance is not the end-all-be-all,” Hittle said. “That’s why the coordination of the health care system and the housing system is going to be so critical.”

In a prior interview with the Capital Chronicle, Hittle said the Oregonians most at risk for homelessness will be eligible for the housing benefit. Often, that’s people who are going through a transition: parolees leaving prison, youth aging out of the foster care system and people with severe mental health conditions.

Hittle said services will be tailored to the person’s needs.

“A person who is homeless may need six months worth of rental assistance,” Hittle said in the interview. “Or someone who was at risk for homelessness, who may need rental help in order to maintain their housing, may get two months worth of rental assistance. So it’s really based on the individual.”

This means agencies and providers will need to work closely together – even if they haven’t in the past, Hittle said. Those groups  include housing providers, community organizations and others.

And the state will have to train people on how to use the system, including people outside the health care industry like community organizations that provide housing and nutrition.

“This is something that the neighborhood providers who interact with us have never had to do before,” Hittle said in the interview.

State officials are asking for patience as the project unrolls next year.

“It’s not going to be perfect,” Hittle told the audience. “It’s not going to be anywhere near perfect in the first five years, but we need to be able to make it so that we can show progress for the people that we serve.”

For health care providers and officials, that’s key to ensuring the new Medicaid plan doesn’t fail.

“If it’s not going to work for the housing providers or the nutrition providers or the climate advice providers, it’s not going to work for our members,” Hittle said. “It’ll be a wasted opportunity.

Arreola, of the Governor’s Racial Justice Council, told the audience to be willing to change their organizations so the new program works for Oregonians.

“Challenge your system,” he said. “Challenge your organization. Don’t be afraid to rock the boat.”

Westrick, with Trillium, said Medicaid insurers will need to coordinate even more than they do now to help people access all the services.

“Listening to our members and hearing how they need to receive those services is really an important piece,” Westrick said.