With 92,700 Oregonians filing for unemployment in a single week, many people may not have access to the health insurance they need during a pandemic. With the expansion of unemployment insurance (UI) benefits, as well as the federal allowance to provide broadened eligibility to state Medicaid programs, we know many people will likely be filing for Oregon Health Plan (OHP) benefits as well.

Currently, one in four Oregonians are served by OHP, the state-based Medicaid program that delivers care through coordinated care organizations (CCOs). In a report completed by Health Management Associates, as many as 430,000 Oregonians could lose their health coverage, and most of those people—about 320,000—would turn to OHP coverage. This report lays out three different scenarios, and even the least destructive scenario in the report projects that 149,000 more people will apply for OHP coverage.

Health Management Associates produced studies on how this will affect Medicaid in every state, and found that lower- and moderate-income people are the most likely to lose their jobs and employer-sponsored health insurance. This economic downturn will disproportionately affect younger individuals who earn less than $50,000 annually.

Will the CCOs that serve our state be able to rise to the challenge of this explosion in OHP enrollment? In short, they’re working incredibly hard to.

COHO has been working collaboratively with the Oregon Health Authority (OHA) to provide solutions and recommendations that would allow CCOs to increase access to health care and expand their capacities. Due to this collaboration, OHA has extended report deadlines, paused rulemaking and the rollout of some new programs, and released 100% of the quality pool money that is normally doled out based on positive health outcomes.

The release of quality pool money is to enable CCOs to invest in resources that their community needs right now, like food, rent assistance, housing, increased mental health services, and providing capital to keep rural clinics and other systems afloat, just to name a few.

This quality pool money isn’t just a blank check though – CCOs are required to provide documentation about planned community investments to ensure this release is going strictly to COVID-19-related investments.

Other than working with OHA to increase capital and decrease administrative reporting, our CCOs are working around the clock to launch call centers, provide food resources to children and elderly adults, and others in need. CCOs are also reinventing current programs in new and creative ways. For example, some CCOs are utilizing their Non-Emergent Medical Transport (NEMT) independent contractors who normally drive patients to doctor’s appointments to deliver food to those that may be medically fragile.

Our state’s work to provide resources and work with our CCOs, as well as the current success of aggressive social distancing measures, make us feel hopeful that our CCOs will have enough capacity to serve increase a greater number of Oregonians through this time.

Do you have ideas on how your COHO CCO could invest in your community? Share them with us here.

With 360,901 identified cases of the novel coronavirus in our country, the state of New York has been identified as the epicenter of the outbreak and carries more than 130,000 confirmed cases. For weeks, New York Governor Andrew Cuomo has been calling on President Trump to use the Defense Production Act to secure more medical equipment and has also requested that the federal government release the 20,000 ventilators in stockpile to New York.

Despite his many calls for help, New York received only 400 ventilators from the Federal Emergency Management Agency (FEMA). The state is now due to run out of ventilators as early as this week.

Oregon Governor Kate Brown heard his concerns and decided to act.

Thanks to Oregon’s aggressive social distancing measures, Oregon is on the right path to “flattening the curve,” leaving our state in a good position to aid other states that need assistance.

In an official statement, the Governor’s office said, “If Oregon later finds itself in need of ventilators, New York and other states will respond to our call for assistance.” Governor Brown in a later tweet said, “Oregon doesn’t have everything we need to fight COVID-19 – we need more PPE and testing – but we can help today with ventilators. We are all in this together.”

Currently, with the outbreak at its peak in New York, there are more than 15,000 people hospitalized, with more then 4,100 of those people not only in critical care, but also needing access to ventilators.

This unprecedented step taken by Governor Brown to aid another state doesn’t seem to be the last act of good our states will be taking. Shortly after Governor Brown made her decision to send ventilators to New York, Governor Gavin Newsom of California decided to take similar steps by loaning ventilators to states where COVID-19 is taking a heavier toll, like the state of New York.

Not only are our states working together to get each other much-needed ventilators, Governor Newsom announced yesterday that the State of California just inked new deals to manufacture 200 billion N95 masks per month. This huge increase in masks will not only meet the needs of Californians but could help other states with their shortage of personal protective equipment as well.

What should I do if I lose my job?

Due to the Covid-19 outbreak, our unemployment benefits are quickly being expanded to include those that are out of work due to the virus. If you would like to apply for unemployment benefits, you can do so here. If you are still employed, but need sick time, here is a resource to walk you through your rights to sick time.

What should I do if I lose my health insurance?

If you have been laid off, you may be eligible for Medicaid, a government-funded insurance plan. You can apply for those Oregon Health Plan benefits here.

What should I do if I need access to mental health services?

If you are enrolled in the Oregon Health Plan, you should have access to a mental health provider, but we recognize that sometimes wait times or lack of providers taking new patients might be a concern. Here are some more resources:

What should I do if I believe my family needs food assistance?

If you are concerned about where you next meal may come from, or think your family might need SNAP assistance, you can apply for those benefits here. Here are some more food resources:

What should I do if I am concerned that someone isn’t following the Executive Order?

Governor Brown’s executive order of “Stay Home, Save Lives”, is enforced through a complaint system, in which Oregonians hold each other accountable for not leaving their homes, and operating their businesses in a fashion that follows this order. However, if you’re interested in reporting someone that may not be complying with the order, please do not call 911. You can file a report by calling the police non-emergency line. That number is: (503)823-3333.

I’ve heard rumors that gas stations are moving to self-service only, is this true?

Long story short, no, the rumors aren’t true. Our state clarified the temporary suspension of full-service gas pumping, saying that self-service is not mandatory. This policy was put into place as gas station owners struggle to fully staff their businesses, due to illness, childcare issues, and safety concerns. The only time self-service gas will be mandatory is if the state’s gas station workforce continues to dwindle, and you happen to get gas from a station that does not have enough staff to complete full-service gas requirements. Don’t know how to pump gas? Learn here.

Oregon Legislators were due for a special session before the novel coronavirus pandemic hit our doorstep to address unfinished business from the 2020 Short Session. Little was accomplished in the short session due to partisan walkouts, and critical budgets remain unpassed. Now that legislators and other public officials are working on economic relief from the COVID-19 pandemic, pressure to call a special session continues to rise.

This begs the question, when will the Governor call a special session, and what legislation will be considered? Will any of the 250+ unpassed bills from last session make a comeback, or will we be focusing solely on the crisis at hand?

We know the Legislature created a Joint Committee on Coronavirus Response, which includes a roster of 16 legislators called upon to assemble a stimulus package for the State of Oregon. This committee held four separate meetings in which legislators heard from industry leaders, agency directors, and experts. Members of the public were encouraged to submit written testimony for legislators to consider.

Now that our legislators have all the information and recommendations they need, it’s time to get down to crafting legislation in the form of a stimulus package. Our sources have shared that the Legislature is working around the clock to find solutions to support Oregonians through this time. It is our understanding that despite the differences our legislators have had in the past, they are working to create a bipartisan bill that will garner support from all legislators even before a special session is called. We are hopeful the Legislature can come to an agreement in the next week or two and call for a single-day session before mid-April.

Do we think that Leadership will allow legislation other than the coronavirus stimulus package? Maybe. But only if that legislation is fully bipartisan and will not cause tension between the parties.

 

All our member CCOs are doing stellar things during this pandemic to aid their communities, but this week we wanted to share what Advanced Health CCO, located Coos Bay, is doing for its members!

In Coos Bay, Oregon, elderly folks make up about 28 percent of the city’s population, with a similar proportion in Curry county, also served by Advanced Health. Due to the high number of elderly Oregonians, Advanced Health CCO serves a population that is at high risk of contracting COVID-19, as well as having medical complications due to the virus. Because Advanced Health is incredibly engaged in its community and understands its members’ needs, it decided to start a pilot program to deliver needed groceries and supplies to those most at risk.

This pilot project is a community-wide plan between several different agencies and community partners coming together to serve elderly, disabled, medically fragile, and low-income Oregonians during the COVID-19 “Stay Home, Save Lives” executive order. A standardized screening will be shared between community agencies, so that case workers and other staff can reach out to current clients and screen them for essential needs related to food, medicine, and Durable Medical Equipment (DME), which some people need due to health conditions. Not only is Advanced Health reaching out to its community, they are also working to provide a centralized place to call for assistance.

As individual needs are identified, Advanced Health and its community partners get to work to deliver food, medicine, and DME! The community is leveraging resources by re-purposing or expanding upon existing resources such as Meals on Wheels program, who will now also be able to deliver other types of essential services. In Curry County, multiple funding sources are coming together to support an expansion of the Coastline Neighbors non-profit, which will provide delivery of essential needs and routine check-in phone calls. The method of delivery will vary based on the individual’s location and needs, meaning that Advanced Health is working to create several options for delivery of food, medicine, and medical equipment!

As the regional CCO for Coos and Curry counties, Advanced Health is working to support collaboration and partnerships with community and social services agencies, including workforce development, public health, and non-profit agencies, to expand services and the volunteers necessary to make this operation successful. We are proud to put the needs of our members and community first.

Thank you, Advanced Health, for all your hard work!

Last week, the federal government passed a stimulus package aptly named the Coronavirus Aid, Relief, and Economic Security (CARES) Act. This policy provides resources for individuals, small businesses, health care providers, hospital systems, corporations, and many more.

We’ve all heard about the federal legislation that will supposedly provide cash payments to Americans, but what does it really do? We went through the bill to see how it will affect people in our state, and in particular, the health care delivery system.

First, the truth about the cash payments to Americans: will every American receive $1,200 being reported in the news? The answer is yes, most adult Americans will have access to this cash payment, though some groups have been left out. According to the exact verbiage, individuals with a social security number earning up to $75,000 (based on 2019 income) will receive rebates of $1,200 per individual and $500 per child under 17. The payments scale down for those earning up to $99,000, and those earning above $99,000 will not be eligible for the rebate. You must have filed your taxes this year or last year to be eligible, and these rebates will only be garnished if back child support is owed.

The CARES Act also bolsters unemployment compensation by adding $600 to every unemployment compensation check, so no one will receive less than $600 per week through July 31, 2020. Medicaid benefits have also been expanded to include those that have been laid off or furloughed without pay due to COVID-19. Those who are self-employed, gig workers, independent contractors, or those with irregular work history are not usually covered, but under the CARES Act, they will be.

Businesses large and small shouldn’t fret! Rolled into the Act is relief in the form of tax credits, loans and loan relief, grants, and other emergency economic programs.

Though the CARES act is mainly an economic stimulus package, it does include rule and regulation changes for health care entities, as well as specific resources for providers, hospitals, and clinics. For example, many hospitals and clinics have significant concerns about cash flow due to the mass cancellations of elective services. The CARES Act creates the opportunity for hospitals to receive accelerated payments, in which qualified facilities can request a lump sum or periodic payments that could reflect up to six months of Medicare services. This direct injection of capital to our health care system is much needed, as hospitals stock up on supplies and continue to pay their nurses, doctors, CNAs, and many others.

This act also increases Medicare reimbursement COVID-19 patient care by 20 percent. This add-on payment recognizes increased costs incurred by providers and will be applied through the duration of the pandemic. Even providers and clinics that do not care for COVID-19 payments will see a two percent increase in Medicare reimbursement through December 31, 2020.

These increases in reimbursement and loan opportunities will help keep providers focused on caring for their patients. Find a more comprehensive list on how this legislation may affect you here.

Late last week, the Oregon Health Authority (OHA) received word from the Centers on Medicare & Medicaid Services (CMS) that most of our state’s 1135 waiver has been approved. This federal document allows flexibility in our Medicaid delivery system during times of crisis, in order to allow providers and coordinated care organizations (CCOs) to pivot from providing preventive care to playing a role in hampering the effects of the novel coronavirus.

CMS’s approval letter details the changes that are allowed through the waiver and creates a timeline for the increased flexibility, as well as mentioning that more flexibility may be coming soon from the remainder of the waiver. With a retroactive start date of March 1, 2020, our 1135 waiver will allow OHA several areas of flexibility that will increase access to providers, prescriptions, and other health-related services. As we know, needs for health care and basic resources are at an all-time high for many Oregonians.

OHA will temporarily suspend Medicaid fee-for service prior authorization requirements, extend pre-existing authorizations, and suspend pre-admission screenings and Annual Resident Review Level I and II Assessments for 30 days. In a time when many people are being laid off without access to health insurance, this decrease in “red tape” will allow people to access needed prescriptions.

In order to increase our state’s capacity to care for those in need, the waiver also authorizes Oregon to enroll health care providers that are enrolled with other State Medicaid Agencies and outlines criteria to reimburse out-of-state providers. This change, combined with Oregon’s initiative to fast-track licensing doctors and other providers who have retired, will increase capacity in our health care system.

In order to increase our state’s number of health care facility beds, the waiver also allows facilities that don’t normally provide Medicaid services to be fully reimbursed for services provided during the public health emergency, provided they meet minimum standards. These types of facilities may include nursing facilities, psychiatric residential treatment facilities, or intermediate care facilities for individuals with intellectual or developmental disabilities.

CMS has also issued a blanket emergency declaration for the entire country, which clarifies procedures in specific instances.

On Tuesday this week, OHA announced that they had received even more flexibility from this waiver and sent a press release discussing the changes. According to OHA, all members who are currently enrolled in OHP will not lose coverage through this crisis, and individuals signing up for new coverage will not have to verify their income, which will allow Oregonians access to OHP coverage much more quickly. OHA also mentioned that stimulus payments and increased unemployment benefits will not affect OHP eligibility, as income will not be counted during the application process.

These regulatory changes will allow Oregonians access to much-needed services, as well as create flexibility for our providers so they can fully focus on the task ahead. We applaud OHA’s work on this waiver and hope OHA will continue to work with Oregon CCOs on next steps in hampering the effects of this virus.

While all of our member CCOs are doing amazing things in their communities, this week, we decided to highlight the work that AllCare Health has been putting in to ensure that the children in their service area do not go hungry, despite the closure of schools.

Most children attending school in the Three Rivers School District are on a meal assistance program (MAP), meaning that they receive free or reduced cost lunches while at school. While schools are closed due to the pandemic, the children on MAP would not have access to meals normally provided to them on a daily basis. For children living in poverty, their main nutrition comes from the meals they receive at school.

Because AllCare Health is so ingrained in their community, they knew how many children rely on this food resource, and immediately took action to fill that gap by partnering with the Oregon Food Bank and the Three Rivers School District.

At the end of the day, AllCare Health and partners were able to donate, package, and deliver 180 boxes of food that all clocked in at about 9 pounds of weight. Why 9 pounds you ask? Because the staff at AllCare health wanted to give as much food as possible, but also wanted children to be able to carry their food boxes home if they had to walk to pick it up. Not only did these amazing partners consider the weight of their food package, they also made decisions about what to include in it, based on what would be easy enough (and yummy enough!) for children to cook on their own, as many parents may still have work obligations during the day.

A lot of hard work and brainstorming went into ensuring that these meals were given out in a timely fashion. In fact, several AllCare staff members personally hand-packaged and delivered these boxes of food to different schools throughout the district, all because they wanted to give back to their community. Sam Engel of AllCare Health said, “We wanted to make sure that our families, our neighbors were getting what they needed during this time.”

Originally, this relief was only planned for the two weeks Oregon schools were supposed to be closed. With the extension of school closures to April 28, AllCare intends to continue this program for the next four weeks in conjunction with its partners. Though the current pilot project is in coordination with the Three Rivers School District, AllCare Health is working with other school districts to expand this program to other areas.

In an official statement, AllCare Health said “The AllCare Care Coordination department is acutely aware that food insecurity is the number one social determinant of health challenge in our community.” AllCare Health is so committed to ensuring that Oregonians have access to food, they are coordinating several other food-resource services specifically for the COVID-19 pandemic. Another initiative AllCare Health is undertaking is the utilization of traditional health care workers to deliver groceries to the curbs of their most vulnerable members.

Thank you, AllCare Health, for your dedication, expertise, and genuine concern for your community!

As Oregon grapples with the COVID-19 pandemic, CCOs are well-positioned to help Oregonians access health care. At its core, the CCO model is designed to keep people out of emergency departments and hospitals. In a time when we are expecting a huge surge of people to utilize hospitals for emergency care, CCOs’ ability to keep Oregonians out of much-needed hospital beds for non-COVID-19 reasons is absolutely paramount.

We stand ready to assist and partner with OHA in any manner helpful, and we appreciate the agency’s work to provide flexibility during this crisis.

All the member CCOs of the Coalition for a Healthy Oregon are working daily with Oregon Health Plan members, participating providers, state and county health departments, and other community partners to keep people healthy and meet basic needs, as well as support our amazing health care providers. Because our CCOs are experts at delivering high-quality health care and are uniquely qualified to advocate for their communities, they put their heads together to offer reasonable and sustainable policy options for policymakers to consider as they work to find solutions.

Speeding up enrollment: As many people get laid off or furloughed without pay, we know that individuals and families might lose health insurance or become eligible for Oregon Health Plan (OHP) benefits. One idea to maximize continuity of care is to presume Medicaid eligibility for people who already receive unemployment benefits or Supplemental Nutrition Assistance Program (SNAP) food resources. This “presumptive eligibility” would allow CCOs to connect Oregonians with health care services in a timely fashion, preventing unnecessary hospitalizations. If a large number of Oregonians suddenly become eligible for OHP, it may be necessary to expedite the process of securing approval for capacity limitation increases.

Breaking down barriers: We appreciate Governor Brown and OHA for the speedy submittal of an 1135 waiver and State Plan Amendment to the federal government. Securing approval from the feds will allow CCOs to bypass certain requirements on utilization management, i.e., waiving prior authorizations and allowing people to receive care faster, including those who may be suffering from COVID-19. These measures will also allow CCOs to reimburse providers for telehealth services at a higher rate, and thanks to leniency from the Centers for Medicaid and Medicare Services (CMS), health care providers will be able to use a wider range of video technology for telehealth services.

Unprecedented community investments: CCOs have doubled down on food, housing, and other Health-Related Services to make sure no one falls through the cracks. Several of our CCOs have already taken action, using their social determinants of health investment dollars to ensure that children have access to food. While this funding cannot be sustained indefinitely, the state can take meaningful actions to support its continuation. One solution would be providing financial credits to allow these critical community investments to continue. Another solution could involve flexibility in how reserve requirements are calculated.

COHO is proud to serve the state and will continue to be a partner. As we navigate these issues together, CCOs will continue to do what we do best—care for our communities.

Yesterday morning, Governor Kate Brown issued an executive order broadening the types of businesses required to close their doors during the COVID-19 pandemic and creates a penalty for those that seek to break the order.

Though it may seem similar to the “shelter-in-place” orders that states around the nation are utilizing, our executive order differs in one major way. During a shelter-in-place order, the government creates a list of “essential businesses/services” that can stay open, because they provide health-related services, give residents access to food, like grocery stores, or are otherwise considered essential because our society could not function if they fully closed. In our state, the Governor simply expanded her previous executive order, by including more businesses to the list that must close. This will allow our state needed flexibility during this uncertain time.

The Governor’s office and Democratic legislators are sharing images like the one here, which are very clear about what residents can and cannot do under this executive order, as well as what businesses are to be closed temporarily.

Residents should and can: stay home as much as possible, stay at least 6 feet away from others when you go out, go out for essentials like groceries and medical care, exercise outside like hiking and biking as long as you can maintain your 6 foot distance from others, and drop food off to neighbors who can’t go out.

Residents should not: gather in groups, get together with friends, have play dates for kids, or make unnecessary trips.

These are the businesses that are still operating: grocery stores, banks, pharmacies, bars and restaurants for takeout and delivery only, some other stores (as long as you’re 6 feet away from other people!), and gas stations.

These are the businesses that have been asked to temporarily close: malls and retail complexes, fitness, yoga and dance centers, barbershops, hair and nail salons, spas, cosmetic stores, tattoo parlors, theaters, amusement parks, arcades, bowling alleys, skating rinks, museums, concerts, sporting events, festivals, campgrounds, pools, skate parks, playgrounds.

The executive order will be enforced on a complaint-based system, meaning that Oregonians not following the order will be ticketed after a complaint has been received, and an investigation completed.

Experts believe that the critical timeframe to stop the exponential growth of cases in our state begins this week, on March 24, 2020. Let’s be sure we’re fulfilling our social responsibility by working from home as we can, and only leaving our house on necessary errands.