More Oregonians Qualify For Health Benefits

Oregon is now able to offer free health care coverage to people in more income categories through a new benefit called Oregon Health Plan (OHP) Bridge. An estimated 100,000 people are anticipated to eventually qualify for the new program.

Oregon created the new eligibility category through a Medicaid demonstration assuring coverage for American Indian/Alaska Native populations and by establishing a Basic Health Program (BHP). Oregon is the third state in the nation to establish a BHP.

OHA Director Sejal Hathi, MD, MBA, said, “Oregon Health Plan was one of the first Medicaid programs in the country to expand to adults with lower incomes. The new OHP Bridge program continues Oregon’s long history of leading the nation in efforts to make health coverage accessible to everyone in Oregon. It also advances our strategic plan to eliminate health inequities by 2030, by helping to expand access to affordable care for all and honoring our government-to-government relationship with the Tribes.”

What makes OHP Bridge different?

Oregon’s BHP will be administered by OHP, which also administers the state Medicaid program. The name references the goal to “bridge” the health coverage gap between people who have traditional OHP and people who have Marketplace coverage.

OHP Bridge will have no member costs, which means no premiums, co-payments, coinsurance, or deductibles. Oregon will be the first state to offer a BHP with no out-of-pocket costs for members.

CMS Administrator Chiquita Brooks-LaSure said, “The Biden-Harris Administration continues to take every opportunity to make health care coverage accessible and seamless for everyone eligible for our programs, and we applaud Oregon for their launch of their Basic Health Program—the third such program in the U.S. Oregon will offer people there a critical lifeline to health care coverage that’s affordable and within reach. For countless individuals and families, health insurance is not just a policy; it provides the opportunity to focus on the well-being and happiness of their loved ones, without the constant fear of financial ruin due to illness or injury.”

Through OHP Bridge, people in Oregon can get medical, dental and behavioral health care with no member costs. Members will also have access to additional benefits, like transportation to medical appointments and other health-related services.

There are a few things OHP Bridge will not cover that other Medicaid programs cover. OHP Bridge will not cover Long Term Services and Supports that help with tasks of daily living, or Oregon’s new Health Related Social Needs benefit, which covers some climate, food and housing needs.

The federal government granted OHA approval to move forward with OHP Bridge on June 24.

Keeping people covered

Before the COVID-19 pandemic, many adults in Oregon with income just above traditional Medicaid limits were uninsured. Additionally, about 34% of members who lost benefits would return to Medicaid within a year due to fluctuating income. OHP Bridge will help people keep their coverage and their same doctors despite short-term fluctuations in income.

“Virginia Garcia is excited to hear that so many individuals here in Oregon will not have to go without health insurance, thanks to the new OHP Bridge plan,” said Virginia Garcia Chief Executive Officer Gil Munoz. “Our patients rely on the services we provide to stay healthy, and this plan will make that possible.”

Who qualifies?

People in Oregon will qualify for OHP Bridge if they:

• Are 19 to 64 years old;
• Have an income between 138 percent and 200 percent of the Federal Poverty Level (FPL);
• Have an eligible citizenship or immigration status; and
• Do not have access to other affordable health insurance.

*These income limits change in March of each year per federal guidelines.

Starting July 1, people in Oregon can apply for OHP Bridge by going to ONE.Oregon.gov.

Moving to OHP Bridge from Marketplace coverage

People who have coverage through the Oregon Health Insurance Marketplace and are potentially eligible for OHP Bridge will not automatically move when OHP Bridge launches.

If someone with a Marketplace plan is potentially eligible for OHP Bridge, they can potentially keep their coverage and financial help until their automatic re-enrollment period ends if there are no changes to their application. If someone makes any updates to their Marketplace application, like a change in contact information or income, their information may be sent to the state to determine eligibility for OHP programs, including OHP Bridge. There will be additional information for current Marketplace members ahead of open enrollment in the coming months.

Updates must be reported even if they cause people to move to OHP Bridge. This includes changes like moving or an increase or decrease in income. If individuals do not update their application, they may lose financial help from the Marketplace.

Applying for health coverage

Starting July 1, 2024, people in Oregon can apply for OHP Bridge.

• Online. To apply online, individuals can go to benefits.oregon.gov. Individuals can also use that link to find information about how to apply in person, to get help to apply, or to get a paper application.
• By phone. Individuals can apply over the phone by calling the ONE Customer Service Center at 1-800-699-9075. All relay calls accepted, and help is available in many languages.
• With an expert. People who want to explore their health coverage options should reach out to a health coverage expert. Experts are available across Oregon to provide free one-on-one assistance. Individuals who would like help should visit OregonHealthCare.gov/GetHelp to find someone near them.

Not sure where to start? Visit the Window Shopping tool at OregonHealthCare.gov/WindowShop. After answering a few quick questions, you will find out what programs, coverage and savings are available to you and your family.

Video of OHA’s press conference is available in English and Spanish.