Read about: an important message for providers
During the COVID-19 public health emergency, rules about the Oregon Health Plan (OHP) changed. For those three years, most OHP members could keep their coverage even if their income went up or they qualified for Medicare.
As you may know, the public health emergency ended May 11, 2023. That means Oregon is returning to its previous policies for OHP, initiating a "redetermination" period. Redetermination is when the Oregon Health Authority (OHA) evaluates an OHP member’s information to determine if they meet eligibility requirements to still qualify for OHP. (Please note: We are not using the word "redetermination" in member-facing materials, because this is an unfamiliar term for most members.)
A member cannot complete redetermination through Columbia Pacific CCO; they must do so through OHA. However, Columbia Pacific CCO will help support members through this process by answering questions, helping them update their contact information, and providing a warm handoff to OHA.
For the most up-to-date information, please visit the OHA website.
Below, find some answers to common questions.
Individuals currently covered by Medicaid will have to redetermine at some point and will receive a notice between May 2023 and January 2024. Members will not lose their benefits immediately. If they no longer qualify, they will have 60 days before coverage ends to find coverage elsewhere.
Normally individuals have 30 days to respond to the request for documentation, but OHA is allowing individuals 90 days to respond to their renewal notice.
Members can update their contact information online, by phone, or in person.
Online at benefits.oregon.gov
Members should respond to information requests and submit renewal forms right away if they receive them. It is important they provide the information the state needs to help them continue to receive benefits or connect with other resources when they don’t qualify or see a reduction in benefits.
If a member has kept their income information up-to-date with OHA and still qualifies, they will receive a notice that they are still eligible for OHA. They will not need to take action. Those who receive a notice that instructs them to provide more information to determine eligibility must respond to OHA to determine if they are still eligible.
We have and will continue to work with the OHA on the plan for redetermination. We will also be doing an outreach and awareness campaign to make sure that members update their information and respond to OHA’s notice within the 90- day window.
Coordinated care organizations (CCOs) are not allowed to directly assist members redetermine. But we can help answer questions about redetermination and direct members to OHA for more assistance. Our Customer Service team can help members with updating their contact information, and adding their preferred language and format. Our goal is to provide a warm handoff to OHA and help members feel seen, valued and heard throughout the process.
OHA sent courtesy notices to members toward the end of 2022 asking members to update their information. They have received more than 60,000 responses so far.
Members can choose their CCO during the redetermination process. If they were a prior member of CareOregon, Columbia Pacific CCO or Jackson Care Connect, they will stay with that CCO unless they actively choose another CCO.