Medicaid Funding in Oregon: What We Know
The federal government is in the process of completely overhauling how it spends money. This includes spending on Medicaid services. News about Medicaid funding and concerns about service changes have been swirling since late Spring. While we still do not know exactly how services will change, we do have some answers about what all of this means for us in Oregon. Read on for more about Medicaid services and federal funding changes.
What is Medicaid, exactly?
Medicaid is a joint federal and state program that helps cover medical costs for some people with limited income and resources. The federal government’s Center for Medicaid and Medicare Services (CMS) has general rules that all state Medicaid programs must follow. CMS also sets payment and reimbursement rates for services. Each state runs its own program. This means eligibility requirements and the benefits available can vary from state to state.
Most people associate Medicaid with medical services. It is true—Medicaid does pay for the medical supports of people who qualify. But Medicaid also includes services that help people access and participate in community life. People like seniors who need increased support as they age and young people who have a physical disability use Medicaid services to get what they need. And people of all ages who have been diagnosed and qualified as having an intellectual or developmental disability use Medicaid services to meet their needs across a lifespan. The extent and nature of the services available to individuals who qualify depends on where they live.
Oregon has chosen to use Medicaid services to support people who with intellectual and developmental disabilities (IDD). Oregon’s IDD services are all based in the community rather than in grouped care settings known as institutions. The federal government pays a matching rate for every dollar that Oregon spends toward authorized services for eligible individuals. The match rate varies, but it is usually better than 50%, or better than $1 Federal match for every $1 spent by Oregon. Oregon uses Medicaid match to fund almost all of its services for people with IDD. Your Personal Agent and their Brokerage, your Direct Support Professional and their agency, your Personal Support Worker, and so much more are all funded with a combination of state and Medicaid money.
What is changing about Medicaid?
HR 1 is the federal budget bill passed by congress back in early July. This bill allocates funding to the federal government in many different areas, including Medicaid spending. The bill allocates significantly less money to Medicaid services than has been committed in recent decades. Medicaid services were expanded to more recipient populations and more service types under the Obama administration. Under the Trump administration, we see that the number of people receiving services will have to be reduced, as will the amount of services available to people who do still qualify. HR 1 is big and complex, and there is a lot of information about how to implement cost-cutting measures that will be left up to CMS and other federal agencies to determine.
Bottom line: we know there will be reductions, but we don’t yet know how deep those reductions will need to be or what form they may take.
Slide from Federal Response Forward Together by ODHS and OHA
What does this mean for Oregon?
Oregon’s Department of Human Services and Oregon Health Authority have put together a team of people to keep track of and analyze the information coming out of CMS and the rest of the federal government. That team is working to separate rumor from fact and to calculate how changed rules will impact Oregon’s services and its people. They need to understand that impact both now and into the coming years. With much still missing from the guidance available from CMS, this is very hard work. It is also subject to change as new information comes out from CMS that changes what we thought we understood.
ODHS and OHA co-hosted a webinar for community partners in July to begin to share what they understand so far. The webinar is a two-part series entitled “Federal Response - Forward Together.” The second event will be held on September 30th. The information shared is not specific to IDD services but instead focuses on the primary areas of impact statewide: Medicaid reductions, SNAP and food benefit reductions, and immigration policy and enforcement changes. The information is helpful but the numbers are daunting. Oregon will lose much more in federal funding than it can possibly cover with state resources.
The following are links to the slides and resources shared:
ODHS Federal Monitoring web page
OHA Federal Monitoring web page
Oregon Health Plan (OHP) web page
Oregon Food Bank web page
How can I keep up on news as this rolls out?
Oregon’s state programs will share out information on the websites above as they have it. It is especially helpful to check on the ODHS Federal Monitoring web page to see how this situation is developing.
Eventually, Oregon’s Office of Developmental Disability Services and our whole IDD community will likely have to come up with a plan to cut costs that will change our services. This will be hard work. But we will come to a better solution if we work together and all agree on what we are trying to preserve. We will share any and all information on this topic as it develops.