Recorded presentation

Matthew J. Carlson, PhD, Sociology, Portland State University, PO Box 751, Portland, OR 97207, (503) 725-9554, carlsonm@pdx.edu, Tina Edlund, MS, Department of Administrative Services, State of Oregon, Office of Oregon Health Policy and Research, Public Services Building, 255 Capitol St NE, 5th floor, Salem, OR 97310, Bill Wright, PhD, CORE, Providence, 5211 NE Glisan, Portland, OR 97207, and Charles A. Gallia, Oregon Office of Medical Assistance Programs, 500 Summer Street, NE., E-35, Salem, OR 97301.

Objectives: This study examined the impact of recent changes in the Oregon Health Plan (OHP) including benefit reductions and increased cost-sharing on Medicaid enrollment, health care access, and health care utilization.

Methods: A multi-wave mail-return survey was conducted in English and Spanish on a probability sample of 10,000 OHP members, along with an oversample of 1500 African Americans, Native Americans, and Hispanics, all of whom were enrolled in OHP immediately prior to benefit changes in February 2003. The survey was constructed from nationally recognized instruments, including the CAHPS„¥ and Community Tracking Surveys, and assesses enrollment, health care access, health care utilization and financial impacts in the six months following benefit change implementation. While the survey is still ongoing, with two mailing waves and a telephone follow-up effort underway, early results are available based on the responses received to date (17%, n=1543). A demographic comparison of responders and non-responders suggests that the responders are representative of the OHP population as a whole. Current results exclude Spanish language surveys, which are still being conducted.

Results: Compared to those with no cost sharing, OHP enrollees who experienced increased premiums and copays were significantly more likely to be uninsured in the 6 months following implementation of cost sharing (11% vs. 40%, respectively). Most were uninsured because they could not afford premiums (36%) or could not afford co-pays (29%). Of those who lost OHP coverage because of program changes, 72% reported that they had no insurance coverage of any kind. Despite their inability to pay out-of-pocket costs, 76% reported that paying premiums was °µworth it°¦ to prevent higher future health care costs. Uninsured respondents were much more likely to report unmet health care needs (56%) than those who retained OHP coverage (34%). Compared to those retaining insurance, uninsured respondents were five times more likely (2% vs. 11%, respectively) to consider the emergency room their usual source of care. Despite this, hospitalizations and emergency room use was comparable for insured and uninsured respondents in the 6 months following benefit changes.

Conclusions: These data indicate that OHP members who lost their coverage value health insurance coverage but could not afford to maintain it. Additionally, loss of coverage resulted in increased barriers to health care services for former OHP members who were more likely to indicate that the emergency room was their usual source of care. When considering reductions in Medicaid benefits, policy makers should assess the likely increases in health care costs associated with unmet needs and the possibility of increased emergency room utilization.

Learning Objectives: At the conclusion of the session, participants will be able to

• Identify recent Changes in the Oregon Health Plan.
• Describe the impact of benefit changes on Medicaid enrollment, unmet health care needs, and health care utilization.
• Articulate the potential financial impact of changing Medicaid benefits.

Keywords: Access to Care, Medicaid

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation