Oregon's Healthcare Transformation

With the passage of health care reform, Oregon moves forward on major changes to our health care system. From the Health Insurance Exchange to Community Care Organizations, find important information that will help you find your way through the changes.

Medicaid Expansion

Beginning in 2014, the Affordable Care Act extends Medicaid coverage to all individuals between ages 19 and 64 with incomes up to 133 percent of the federal poverty level, or $14,856 for an individual and $30,656 for a family of four (based on the 2012 federal poverty level).

For example, an uninsured 55-year old woman with no children who is a server in a restaurant that does not offer insurance could qualify for Medicaid under this new coverage group if she earns less than $14,000 in a year. Children are currently and will remain eligible for either Medicaid or CHIP at higher income levels based on the eligibility standards already in effect in their State. New federal matching rates will provide 100 percent federal funding for newly eligible individuals for three years (CY 2014 – 2016), gradually reduced to 90 percent in 2020, where it remains permanently. This increase in federal support for the Medicaid program will result in savings for States.

CMS has released the final rule on Medicaid expansion set to take effect on January 1, 2014. This is guidance to the states so each of your states will have to implement these requirements (assuming the Supreme Court rules this Constitutional).

Below are links to various documents that you might find useful.

• Medicaid CHIP Eligibility Rule Fact Sheet
• Medicaid Eligibility Final Rule 42 CFR Parts 431, 433, 435, and 457 “Medicaid Program: Eligibility Changes Under the Affordable Care Act of 2010”
• Press Release announcing the release of the Final Rule
• Final Rule Regulatory Impact Analysis
• Under the Affordable Care Act of 2010
• Medicaid Expansion under the Affordable Care Act

The Oregon Health Insurance Exchange

The Oregon Health Insurance Exchange is a central marketplace where consumers and small employers can shop for health insurance plans and get help paying for coverage. The Exchange will make it easier for Oregonians to compare their health coverage options and find out if they are eligible for financial assistance. The health insurance exchange is a central part of the Affordable Care Act. States are given the option to setup an exchange or have the federal government set one up for them.

The Oregon Legislature formalized the creation of Oregon’s Health Insurance Exchange during the 2012 Legislative Session with the passage of HB 4164. The Health Insurance Exchange will begin operating in October 2013.