Beyond the Water's Edge: Charting the Course of Managed Care for People with Disabilities - Conference Resource Book. How the Oregon Health Plan Serves People With Disabilities: System Design Issues and First-Year Impacts

11/01/1996

Margo L. Rosenbach, Ph.D.
Margo Rosenbach is Executive Vice President of Health Economics Research, Inc., Waltham, MA. She is the Principal Investigator of the HCFA-funded Evaluation of the Oregon Medicaid Reform Demonstration, which assesses the impact of Oregon's Section 1115 Medicaid waiver on quality, access, utilization, satisfaction, and program costs. The Oregon Health Plan (OHP) involves expansion of Medicaid eligibility, increased enrollment in managed care, and implementation of a priority list to determine Medicaid benefits. The Disability Component of the evaluation focuses on the impact of OHP on people with disabilities. Dr. Rosenbach is also the Principal Investigator on several other Medicaid demonstration evaluations, and has a special interest in access to care among vulnerable populations. Dr. Rosenbach received her Ph.D. in Health Policy from the Heller Graduate School, Brandeis University.

This research was funded under Contract #500-94-0056 from the Health Care Financing Administration. The statements do not necessarily reflect the views or policies of HCFA. The contractor assumes responsibility for the accuracy and completeness of the information contained herein.

OBJECTIVES OF THE OREGON HEALTH PLAN

  • Expand Medicaid eligibility to those below the Federal Poverty Level, without regard to categorical criteria.
  • Set reimbursement levels sufficient to cover costs, to eliminate cost shifting.
  • Make an overt commitment to managed care, where feasible.
  • Develop a prioritized list of health services that would be used to establish the scope of benefits, based on the availability of State funds.

PHASED IMPLEMENTATION

  • Phase I implemented February 1, 1994 (AFDC, General Assistance, poverty-level pregnant women and children, and Medicaid expansion).
  • Phase II implemented January 1, 1995 (disabled, children in foster care, and elderly).

SYSTEM DESIGN ISSUES

  • Choice Counseling
  • Continuity of Care Referral Form
  • The Ombudsman
  • The Exceptional Needs Care Coordinator
  • The OHP Benefit Package
  • Coordination of Acute Care and Long-Term Care

FIRST-YEAR IMPACTS

  • Provider Issues
  • Consumer Issues
  • Access to Care
  • Mental Health Services

 

 

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