Oregon tops country in share of people retaining Medicaid, study finds

Oregon, known nationally for its innovative approach to Medicaid, has kept more people than any other state on the free health insurance since an unwinding of enrollments started last year, a new study found.

About four of five people enrolled in the Oregon Health Plan have retained Medicaid coverage since April 2023, when the state began examining the eligibility of its 1.5 million enrollees, according to a study by Georgetown University in Washington, D.C. During the pandemic, the federal government offered states extra benefits to keep people enrolled in Medicaid – known as the Oregon Health Plan in Oregon. That meant that even if people’s income increased and they no longer qualified, they still retained free dental, mental and health care benefits.

Oregon’s 80% retention rate is followed by 71% in Arizona, 70% in North Carolina, 63% in Washington state and 62% in Connecticut, the Georgetown study found. Texas was last – barely 4% retained coverage – and Pennsylvania was second to last, with a 5% retention rate.

Oregon’s rate – helped in part by the creation of a new health care plan approved by the Legislature – means that more people have primary care providers and take care of problems early instead of depending on emergency care, said Sean McAnulty, a member communications coordinator at the Oregon Health Authority, which oversees Medicaid.

“The real goal is to get people using more primary care, preventative care services, which catch those health problems early and reduce the overall cost of care to everyone across the health care system,” McAnulty said.

The free benefits, split between the state and federal government, which pays about 60% of the cost, also help members’ financial health, McAnulty said.

Retaining a high percentage of Oregon Health plan enrollees moves Oregon closer to its goal of having 98% of residents covered by some kind of insurance, whether it’s Medicaid, an employment plan, private coverage or Medicare, McAnulty said. The Oregon Health Authority’s 2020 to 2024 strategic plan set the 98% goal as a target for this year. McAnulty said state officials don’t know what the current rate is. Previously, it has hovered around 94%.

A total of 232,000 people have lost Medicaid benefits since the unwinding began, according to the Oregon Health Authority, and they’re being directed to buy an individual plan on the federal health insurance marketplace. Amy Coven, a health authority spokeswoman, said more than 145,000 Oregonians are covered this year by a plan purchased on the marketplace, which is the only place where lower-income consumers can obtain subsidies, often in the form of tax breaks. State officials don’t have access to marketplace data and thus don’t know how many who’ve lost Medicaid bought a private plan, Coven said.

This month, the state launched a new free plan, the OHP Bridge Plan, for those who earn more than the federal income limits for traditional Medicaid – up to 138% of the federal poverty level, or nearly $21,000 a year for one person or more than $43,000 a year for a family of four. The OHP Bridge plan extends Medicaid benefits to those who earn up to 200% of the federal poverty level. That means that individuals who earn about $30,000 a year or families of four who earn $62,400 a year qualify.

Oregon Health Authority officials expect the plan to cover 100,000 Oregonians by 2027.

Health authority officials said extending coverage to people through the bridge plan helped push up the Medicaid retention rate. Nearly 23,000 people who had Medicaid benefits but no longer qualified have been moved to the bridge plan, they said Wednesday.

State officials also tried to keep people covered by Medicaid as long as possible by checking the qualifications of those most likely to retain coverage first and pushing more complex renewals toward the end of the process. Oregon gave people more time to respond to the renewal process than any other state, officials said. Medicaid members have 90 days to respond to a renewal letter, and they are notified 60 days before benefits end. People who failed to respond initially can reopen their case 90 days after losing benefits.

To qualify for Medicaid in Oregon, you have to be a U.S. citizen, permanent resident or legal immigrant and meet the income qualifications. For many people, state officials have been able to verify that information by checking a federal data hub. McAnulty said that earlier in the unwinding process, the state automatically terminated benefits if Medicaid members had reported earning more than allowed, but he said now state officials will ask members to confirm their status before ending benefits.

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