Confirmation Comes of Fed’s Okay on 1115 Waiver

For decades, Oregon has had a waiver from the federal government to allow for state-level innovation in our Medicaid program, the Oregon Health Plan. But the waiver needs regular approval to continue. This past summer, the state submitted our application in hopes of getting the waiver renewed prior to the change in administration. While it has been an extended process, news came today that the application was officially renewed for the next five years.

Oregon has a strong history of innovation in health care, with documented improved outcomes. Oregon’s health reforms are projected to save a total of $10.5 billion between 2012 and 2022 by holding down cost growth to not more than 3.4 percent per member per year. Since our last waiver approval:

  • Avoidable emergency department use decreased by nearly 50 percent
  • Hospital readmissions have been cut by a third.
  • Substance misuse assessments, developmental screening and timely prenatal care have all increased.
  • Federal and state governments saved $1.4 billion in Medicaid costs

The renewal of the waiver will allow Oregon to:

  • Integrated care: Provide integrated physical, behavioral and oral health care services to OHP members through coordinated care organizations (CCOs).
  • Advance the coordinated care model: The waiver maintains the coordinated care model and promotes payment for value rather than volume of services. These models will continue to allow Oregon to improve quality and outcomes and hold down costs to a sustainable rate of growth.
  • Promote increased investments in health-related and flexible services.The waiver provides clarity on how non-traditional services that improve health are accounted for in global budgets. CCOs will be encouraged to invest in services that improve quality and outcomes, and CCOs that reduce costs through use of these services can receive financial incentives to offset those cost reductions.

Contributed by: Stacy Michaelson | AOC Health & Human Services Policy Manager