1. Oregon Covering Kids & Families & State of Oregon Department of Human Services Oregon Health Plan Oregon Health Plan (OHP) Central & the Rogue Valley Covering Kids & Families Collaborative

2. Aim Statement To reduce the “pend” rate for Oregon Health Plan applications by 15%.

3. Who Are We? The Oregon Health Plan, a Medicaid demonstration, was implemented February 1994. OHP Central is a centralized processing center located in Salem, Oregon, receiving an average of 18,000-20,000 OHP applications monthly from around the state.

4. Who Are We? Cont.. OHP Processing Center is a high production unit which determines eligibility for 70% to 75% of all the OHP Medicaid applications for the State of Oregon. Oregon Health Access Project is the Oregon state lead agency for the RWJF Covering Kids & Families Initiative.

5. Oregon Health Plan Processing Center OHP has 6 regional teams. Specialized phone bank to answer incoming inquiries. Point people to process applications for DV victims and/or pregnant women. Specific teams to process Self Employment and MAA/MAF applications. Exceptional training team with a commitment to success for each employee.

6. Partnership with Rogue Valley CKF in Jackson County RWJF Covering Kids and Families (CKF) grant was awarded to: Oregon Health Access Project (CKF lead agency for Oregon). Local CKF Pilot: Rogue Valley CKF, Jackson County.

7. Partnership Cont.. Southern Oregon is a rural area populated with a high number of low income Oregonians. From the July 1, 2003 preliminary estimates show there are 3,541,500 Oregonians. The population in Jackson County is 189,100 or 5% of the overall population.

8. Project Team Collaborative members include: LoriAnn Sheridan, Tim Miller, Michele Wallace and Lisa Hendricks. OHP Central Project Members include: Carlie Jackson, Randi Burckhardt, Karen House and Sheila Tolleson. Beginning November 1, 2003, OHP has 2 dedicated staff to determine eligibility and track data from randomly assigned applications.

9. What we will track.. Reasons why we pend: IncomeArrearsAddendumSignatureOther Reason why we deny: ArrearsIncarceratedOver Income Failure to respond Not a resident Standard clients with private ins. OtherOver Resources Child with private insurance CAWEM Medical only Over Resources for children Premium Disqualification

10. Baseline Statistics

11. Stats Cont..

12. Stats Cont…

13. Possible Targets for Improvement Oregon has requested and is waiting for CMS waiver approval on the following amendments: The OHP application is being revised to incorporate the 7211 addendum. Expansion of coverage for the State Children’s Health Insurance Program from 185% to 200% of the Federal Poverty Level.

14. Possible Targets Cont… Redefinition of the Standard Benefit Package. Include RX Drugs, Outpatient Mental Health and Chemical Dependency Services. Emergency Dental Services Eliminate delayed eligibility start date.

15. Oregon Covering Kids & Families & State of Oregon Department of Human Services Oregon Health Plan Thank You!