Finding Uninsured But Eligible Children in Oregon After Major Medicaid Reforms Results from a Statewide Survey of Oregon’s Food Stamp Population Jen DeVoe,

Finding Uninsured But Eligible Children in Oregon

After Major Medicaid Reforms

Results from a Statewide Survey of Oregon’s Food Stamp Population

Jen DeVoe, MD, DPhil

Department of Family Medicine

Oregon Health and Science University

Research TeamJen DeVoeOregon Health and Science University

F32 Fellowship Funding from the Agency for Healthcare Research and Quality (AHRQ)

Lisa KroisOffice for Oregon Health Policy and Research

Tina Edlund Office for Oregon Health Policy and Research

Jeanene SmithOffice for Oregon Health Policy and Research

**Oregon Health Research and Evaluation Collaborative (OHREC)

Oregon’s UninsuredPercent Without Health Insurance in Oregon, 1990 to 2004

(Source: Oregon Population Survey)

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

Year

Per

cen

t U

nin

sure

d

Children (0 to 17) 19.9% 18.5% 12.6% 7.6% 9.4% 8.5% 10.1% 12.3%

All Oregonians 15.6% 18.0% 13.6% 10.7% 11.0% 12.2% 14.0% 17.0%

1990 1992 1994 1996 1998 2000 2002 2004

Changes in the OREGON HEALTH PLAN (OHP)

The initial intent was to expand coverage; however, thousands of Oregon adults lost OHP STANDARD coverage shortly after February 2003.

OHP prior to February 2003

After February 2003:OHP PLUS

After February 2003: OHP STANDARD

Benefits similar to original OHPNo premiums or co-pays

WHO QUALIFIES?All eligible children“Categorical” adults

Leaner benefit packageStricter rules

Requires premiums and co-pays

WHO QUALIFIES?Low-income adults who do not qualify for OHP PLUS

The recent loss of Medicaid coverage for many Oregon adults may have impacted children’s access to health insurance coverage.

We conducted a survey of Oregon’s food stamp families to find out why many eligible children lack insurance coverage and to identify factors impacting their access to healthcare services.

Photo by Jamie Francis, The Oregonian

Methods

• Random sample (n=10,175) of all families with children ages 1-18 enrolled in the food stamp program as of January 31, 2005.

• Mail return, self-report survey with 31% response rate. Respondents were demographically similar to non-respondents.

• We weighted the data back to the original food stamp population (n=84,087 families), and we used a raking ratio estimation process to adjust for non-response.

Nearly 11% of the children in this population, presumed eligible for

Oregon Health Plan, were uninsured.

10.9%Uninsured

16.1%Private

Insurance

73.0%Public

Insurance

Among children in Oregon’s food stamp population, higher rates of uninsurance were associated with being:

• Hispanic

• Older than 14 years of age

• Living in a household earning between 133-185% of the Federal Poverty Level

• Having an employed parent

• Having an uninsured parent

• Having an adult in the household who recently lost OHP coverage

Over 26% of the children had a health insurance coverage gap in the

12 months prior to the survey.

26.3%Coverage

Gap

73.7%Continuous Coverage

Why did children in this population have coverage gaps?

• Family lost or could not afford employer-sponsored coverage.

• Parent did not think their child was eligible for OHP due to income.

• Family missed the OHP re-certification window.

Why was your child uninsured?

“Because I owe money to OHP for back premiums when they dropped adults from the health plans…”

“We own our own business and could not afford insurance premiums…had to wait 6 months to apply for OHP”

“My employer does not offer insurance, and I don’t make enough to get it on my own, and OHP denied us…”

“Their dad was supposed to get them covered through his work, but the cost was too much, and it didn’t happen…”

The most commonly reported suggestions for improving the OHP application process to minimize children’s coverage gaps:

• Extend the time between re-enrollment from 6 to 12 months.

• Decrease the amount of paperwork needed to enroll.

• Shorten the 6 month waiting period, thus decreasing the amount of time children must go without coverage prior to enrollment.

“Healthy Kids” Process

• Governor’s Pledge to Cover All Kids

• Medicaid Advisory Committee – Hearings– Statewide public meetings– Recommendations to the Governor

• Legislative Committee Hearings

• Media Attention

• Legislation Introduced

“Healthy Kids” Proposal

• Expand eligibility – fluidity of coverage, with cost-sharing for families earning >200% FPL

• Extend re-enrollment window to 12 months

• Decrease waiting period to 60 days

• Simplify enrollment

• Aggressive outreach to uninsured kids

• Continue to focus on access to care

Political Realities

• Need funding! – Tobacco tax increase not universally accepted,

will likely go to voters.– Revenue legislation requires 3/5 majority.

• Citizenship concerns

• Opposition to government social programs

• Perception that all children have access to safety net clinics and emergency department

• Partisan politics

Refusal to vote derails Ore. Healthy Kids proposal

4/26/2007, 5:21 p.m. PT By JULIA SILVERMAN The Associated Press

SALEM, Ore. (AP) — A Democratic plan to pay for an expansion of children's health insurance programs by hiking the state's cigarette tax died an ignominious death in the Oregon House Thursday, but only after the chamber's brand of political theater had spiraled into out-and-out farce.

What is Happening With Healthy Kids Now?

Research and Policy Continuum

Policy-Relevant

Questions

Revised Policy

Implemented

Research and

Evaluation

Exploratory Research

Policy ProposalsPOLITICS!

For Further Discussion…

• State/Academic collaborations

• Dissemination of results– Different time-lines (policy vs. academic)

– Multi-State comparisons

• Writing for a diverse audience

• What is the researcher’s role?

Acknowledgements

This study was funded by a HRSA grant through the Office for Oregon Health Policy and Research. Jen DeVoe was funded by a fellowship grant from the Agency for Healthcare Research and Quality.

Thank you to the Office for Oregon Health Policy and Research (OHPR), the Oregon Department of Children, Adults and Families (CAF - food stamp office), the Oregon Office of Medical Assistance Programs, and the Oregon Department of Education.

A special thanks to Janne Boone, Jessica Miller and James Oliver (OHPR); Rebecca Ramsey and Pooya Naderi (PSU); additionally, our appreciation for the efforts of Ron Taylor and Jeff Tharpe (CAF)

“I hope that people "in charge" can get this all figured out for the health and safety of our children – they are our future – please help all of them to survive until then.”

In The Words of One Parent…