Coordinated Care Organizations began August 1, 2012
Oregon leads the nation in comprehensive payment and delivery system reform.  
In waves of enrollment Oregon Health Plan (Medicaid) members will be moved to CCOs.

Among the clients that will not change plans are
"Tribal clients who do not wish to be enrolled in a health plan."

Tribal Consultation with the Oregon Health Exchange "CoverOregon" 

  • CoverOregon has one of the nation's best records (of any exchange) of working with Tribes and the state's Urban Indian Program (NARA).  It has the first consultation policy, most meetings with tribes, greatest level of interaction with Exchange leadership, first American Indian tribal liaison, Tribes as community partners with application asisters, and most advanced plan for tribal sponsorship (tribes paying premiums).
  • The state also has active tribal involvement in Medicaid reform and Exchange Planning  
  • A CoverOregon Tribal workgroup meets regularly and often (monthly).
  • The Health exchange consultation policy makes it clear consultation is with tribes and includes commitment to consult with NARA, the state's Title V Urban Indian Health Program; with consultation facilitated by the Northwest Portland Area Indian Health Board. 
  • First (July 2012) exchange to appoint tribal/urban liaision, the Tribal Program Analyst.
27,000 Uninsured AIANs 

  • Nearly, 16,000 of uninsured AIANs are under 139% of Poverty (estimate).
  • 6,000 newly insured June 2014
  • 11-12,000 are between 139-400%.
  • 2,000 to 4,000 from non-Group coverage to QHPs possible.
  • 47% of 18-25 year olds are uninsured; 57% of 18-25 between 139-400% are uninsured (2,700)
OR and WA comparison
Oregon Insurance Division  will have important responsibilities- 
see 2012 report on health insurance & July, 2012 ACA actuarial analysis. 
Medicare-Medicaid Integration Postponed to 2014.  This is Oregon's pathbreaking 'Duals" Project.
Note:  Error rates are not calculated and likely very high for smaller numbers in some of the estimates
The most important of the many Oregon initiatives are the Coordinated Care Organizations where I/T/U are not so much included as they are exempted.  Many AIANs, however, will join these CCOs.
  • Health Exchange Subsidies 
  • 12,000 of the Oregon's 28-30,000 uninsured AIANs are between 139% and 400% of FPL. 
  • 3,800 are between 139 and 200% of FPL and very very low cost (or no cost) QHP options are available with no or low cost sharing.

  • Medicaid Expansion 
  • 16,000 of uninsured AIANs are under 139% of Poverty. It is very possible that many are already eligible but not enrolled although Oregon is a leader in outreach and enrollment. It is important to remember that these are 'estimates'.  
  • Food Stamp enrollees are now automatically eiligible for Medicaid in a simplified process expect to save enrollment and outreach cost and reach more qualified for Medicaid (Oregon Health Plan)
  • Migration from individual (non group) plans to the Exchange ---estimated 2-4,000.
  • Tribal Sponsorship Program
  • Like the ambitious attempt to link health and social service eligibility processes the sponsorship program 'failed to launch'
  • Key question is will Indian health programs have fair contracts, that utilize the Indian addendum with health plans that provide both fair payment and access to health plans provider networks.
  • In Oregon it is clear tribes can sponsor anyone they choose to sponsor. And QHPs are required to use Indian Addendum in any contracts.
American Indians have far higher percentage than 'all races' under 138% of poverty in most, but not all states 
American Indians have a nearly equal percentage between 138% and 400% of poverty as 'all races'  in most, but not all states and sometimes more than all races.
Oregon's coordinated care effort (updated October 2012)  is described  by several criteria by the National Academy of State Health Care Policy (Map) .
  • Reports Evaluating Oregon's Reforms
  • Robert Wood Johnson/ Urban Institute 2012
Oregon
  • (see NPAIHB- TTAG explanation in a Addendum Companion Document that explains the need for QHP requirement and the practical reason for the use of an Indian Addendum that spells out federal requirements and provides guidance for health plans who have never previously contracted with Indian health programs (either IHS and Tribal).
State regulations that implement special Indian Provisions

  • Oregon Brochures 
Suggested Citation: Website,  Health Care Reform for American Indians and Alaska Natives, Ed Fox, 2015
105 Maple Park Ave SE Olympia,WA 98501
Free and unlimited use granted, citation appreciated
edfox_phd@yahoo.com  360 790 1164
Free and unlimited use granted, citation appreciated
Explanation of these Medicaid expansion estimates (made in 2011) are in the Health Care Reform:  Tracking Tribal, Federal,and State Implementation
Supported State Based Exchange 
September 4, 2014 CoverOR Mtg
Uninsured AIANs in Oregon
According to 2012 ACS estimates, 14,600 or a majority of Oregon's Uninsured were  Eligible for no or limited cost sharing in Cover Oregon and 13,000 uninsured are eligible for Medicaid-
ACS 3 year data 2010, 2011, 2102 has slightly different estimates 
March 22, 2016
  • Oregon Reduces Uninsurance Rate to under 10% and for adult population just 14%
Oregon had about 10,000 uninsured AIAN between 139 and 400% in 2013
As few as 5,500 in 2015.
May 1, 2015 report: Oregon Medicaid increased 69% Washington increased 50%

Kentucky lead the nation with 85% increase in Medicaid.
2015 ASPE Report on Medicaid Increases
2011 Estimate
Suggested Citation: Health Care Reform for American Indians and Alaska Natives, Ed Fox, 2016 Website.
Free and unlimited use granted with citation (suggested citation above).
edfox_phd@yahoo.com  
Click here for ACS estimates for WA, OR, and Idaho estimates of Medicaid increases from 2012 to 2014.