Lane County: New federal rules will ask aid recipients to earn $580 per month

Presenter: Lane County shares the latest on work requirements tied to federal funds. At the Poverty and Homelessness Board’s Executive Committee July 16, Commissioner Pat Farr:

Commissioner Pat Farr: They made a wonderful presentation at the Board of Commissioners yesterday and included discussion of employment requirements in other areas. If anybody didn’t see those presentations, it’s online. The first one—by Director (Eve) Gray—a wonderful presentation. 

Presenter: Here’s that part about how some federal programs will be adding work requirements. On July 15,  Health and Human Services Director Eve Gray: 

Eve Gray (Lane County Health and Human Services, director): As of Jan. 1, work requirements go into effect for the expansion population and Medicaid. So these are individuals aged 19 to 64, and there are a number of reasons that someone might be exempt from the work requirements, particularly related to their medical frailty.

It appears that the first time someone goes through redetermination with the new process, they will be able to self-attest to being medically frail and unable to work, which may mitigate the number of individuals who are then held accountable to work requirements who are not already working.

And then the second time—because we will be on a two-year redetermination cycle until the fall of ’27, when we will go to every six months for redetermination—this is related to a Medicaid 1115 waiver that the state of Oregon has—the second time folks then are redetermined, they will need medical documentation of their medical frailty.

The new rules that came out from CMS say that medical documentation cannot just be codes on a chart. It has to be an actual provider assessment of the disability level of the individual.

We have tremendous trepidation around what documentation is going to be required. How much workload will this be for providers? How do we get every Medicaid member into a primary care provider at the interval that we need to, in order to demonstrate continued disability? 

And none of these questions are yet answered.

The state of Oregon has joined with, I believe, more than 20 other states in a lawsuit around this particular provision because of the administrative burden that is added in the assessment of someone’s level of disability and whether or not that prevents them from working.

But without intervention from the courts at this point, we are anticipating a very large increase in our provider workload without an increase in compensation associated with these changes and difficulty with patient access. We know that that’s a problem in our community. 

So monitoring this, we don’t know how many people will actually fall off though, for this coming fiscal year, because of this self-attestation requirement.

The other thing that we have learned that I think is worth mentioning, just for any public that’s watching, that’s monitoring this, is there’s largely been a statement that work requirements will be 80 hours per month, which it turns out, is not entirely true.

What is true is that if individuals make $580 in a month, they have met the work requirements. 

Commissioner Laurie Trieger: Say that again? Sorry— 

Eve Gray (Lane County Health and Human Services, director): $580 in a month. 

Commissioner Laurie Trieger: If they’ve earned that. 

Eve Gray (Lane County Health and Human Services, director): That’s correct. So in Lane County, our minimum wage is $15.55 cents, as long as Google told me right, I believe that is correct— 

Attendees: As of July 1? As of July 1. Wow. Okay. Yes. 

Eve Gray (Lane County Health and Human Services, director): So that would mean that Lane County members need to work just under 38 hours per month in order to meet the work requirements. 

And of course, that’s minimum wage. But someone who has gig work or someone who’s self-employed, you know, ultimately it’s the dollar amount that they’re looking at.

If they are to meet the requirements by volunteerism or by education, my understanding is the 80-hour requirement will stand.

So still trying to get more on this, but there’s some nuance associated with how people meet the work requirements.

Presenter: Commissioner Laurie Trieger:

Commissioner Laurie Trieger: Do we know—this is a little far afield, but I’m also thinking about a lot of people who are certified in-home care providers, are caring for, like, a developmentally disabled adult child, and they get some reimbursement. Does that count as income? 

Eve Gray (Lane County Health and Human Services, director): It should count as income, and also it should count as an exemption if you are caring for a disabled individual, that should be an exemption from the work requirements.

So there are a lot of people who do this uncompensated, you know, caring for older adults, parents, that sort of thing. And that should count, though we’re still awaiting the actual criteria from the Oregon Health Authority.

They found out recently what the federal rules were. There were many, many pages of those rules, as you can imagine. So OHA is working on getting greater clarity out to us…

Yeah, I’m kind of mixing the big picture with the small picture here because it’s all interrelated.

We are not just taking all of these revenue reductions lying down. We have some options for revenue enhancements. So we have already initiated with the state a process called a scope change request with Medicaid.

This is essentially our way of renegotiating our Medicaid rates with the state.  So we are engaged in that.

Because we have not done this process in many years, we have some optimism that we could see a significant change to our rates, but we won’t know until we go through the process.

The timeline for that is that we will submit a proposed rate sometime this summer. Usually the final rate is within 3% to 5%, but it usually takes OHA about a year to decide where the final rate lands, though they will pay us back to October 1 for any of the rate changes.

So October 1 will be our date where we would see any increases there.

We are looking at some Medicare payment adjustments. We have some opportunity to take advantage of some federal rules that will give us more favorable reimbursement for Medicare and Medicare Advantage.

We have engaged a consulting firm to come in and help us to make sure that all of our paperwork is in order, and we’re billing properly in order to get those enhanced rates.

Presenter: Commissioner Pat Farr:

Commissioner Pat Farr: A question on Medicare, you know, a number of times I’ve carried back to the national conference and Commissioner Trieger carried it at one time, the parity on Medicare payments. Did anything ever come of that—between behavioral health and physical health? 

Eve Gray (Lane County Health and Human Services, director): Not yet. We’re not fully there yet with Medicare—

Commissioner Pat Farr: So that’s for later discussion, but a glimmer of hope is on the horizon that maybe we’ll get some relief there.

Eve Gray (Lane County Health and Human Services, director): That’s the hope, you know—

Commissioner Pat Farr: Everybody’s in favor of it.

Commissioner Laurie Trieger: Everybody’s in favor of it.

Eve Gray (Lane County Health and Human Services, director): From a policy perspective, something that’s very interesting is that the state of Oregon leaned heavily into parity with behavioral health and physical health. And when we leaned into parity, what that meant was that rates for behavioral health providers increased, access increased, utilization increased.

And when you’re looking at the analysis from CCOs, from the Medicaid Sustainability Workgroup, they are largely pointing to behavioral health as what is driving the massive increases in cost in the system.

And so, potentially, some of these recommendations involve looking at behavioral health for reductions. And we’re seeing that also with new prior authorization requirements, new restrictions on utilization that are already happening in behavioral health.

So it is an interesting question around: How long and how hard will we be able to lean into parity? Would we ever be willing to look at the system as a whole and say, okay, the right thing to do is parity and behavioral health, but that means we need across-the-board changes versus what is often the easier approach, which is, ‘Oh, the thing that’s increasing is this, so we need to cut here.’

So we will have to engage pretty heavily in those conversations in the legislative session, I think, as they’re building that next biennial budget. 

Presenter: Lane County shares the latest federal requirements for work or volunteer hours to be eligible for federal funds. 

As of the briefing for commissioners July 15, it would take about 38 hours a month at the minimum wage of $15.55 to earn the threshold amount of $580 per month.