600,000 Oregonians enrolled in Medicaid will receive work requirements letter

Presenter: 600,000 Oregonians will soon be receiving letters from the Oregon Health Authority about changes coming to the Oregon Health Plan. OHA said at a press conference Sept. 21 that they’re preparing to help.

Max Sprague My name is Max Sprague. I am the communications director for the Oregon Health Authority.

Starting this week, 600,000 people or more across Oregon will receive notices that changes are coming to the Oregon Health Plan, Oregon’s Medicaid program. 

These changes will include more frequent renewals and work or activity rules that will require members to prove that they are working, or in school, or volunteering for at least 80 hours a month.

Now we want to be clear. We know that the vast majority of people who are on Medicaid who can work are already working. 

And we know from other states that when people lose Medicaid or the Oregon Health Plan because of these rules, it isn’t because they’re not working or they’re not contributing. It is because of administrative churn. It’s because they don’t check a box. It’s because they don’t know changes are coming. It’s because they don’t answer a text message because it looks like spam. 

It’s because they put a letter that came in the mail into a letter graveyard that sits on their kitchen counter and has been there for a month, because there are just too many other things to do and deal with. 

That’s why we appreciate your help in being here today. We want to make sure that this information gets out as widely as possible to as many people as possible, and in as many accessible ways as possible.

Vivian Levy My name is Vivian Levy, and I’m the interim Medicaid director, and I’m glad to be here with you today to talk about the impacts of changes coming up to the Oregon Health Plan. 

So this week, Oregon began sending notices to 600,000 Oregon Health Plan (or OHP) members about upcoming changes that are required under new federal Medicaid rules. These changes are required because of federal legislation—U.S. House Resolution 1, H.R. 1, also known as ‘The One Big, Beautiful Bill.’

Oregon must follow these mandates to continue receiving federal funding. One of the earliest impacts will be new work and activity rules for people renewing their coverage. These requirements take effect Jan. 1, 2027 for some people between the ages of 19 through 64 covered by Medicaid, which in Oregon is known broadly as the Oregon Health Plan, or OHP. 

I want to be clear about two things. 

OHP members, your coverage will not end at this time due to work or activity rules. If you are likely impacted, you may receive a notice with information about the changes coming in 2027. It’s a federal requirement to send this notice to everyone now. 

But again, your coverage is not ending at this time due to worker activity rules. We know that there are so many hard-working people enrolled in Medicaid. These work rules make an assumption that people on Medicaid are not working or need to get work when the truth is, a majority of adults with Medicaid coverage who can work already do. 

Because of these new federal rules, some people may need to provide extra information next year in order to keep their coverage. 

Before we get into more details about the changes ahead, let’s talk about where we are today when it comes to health coverage to understand where we’re headed. 

One of our core values in Oregon is ensuring that people can access health care regardless of income. That matters because when health care is within reach, kids, families, and communities as a whole are healthier. 

We’ve made great strides in Oregon, both in helping people get health coverage and ensuring that they can maintain access to health care once they have that coverage.

The Oregon Health Plan has helped keep people covered. It provides access to health coverage for individuals with lower incomes, covering doctor’s appointments, hospital care, behavioral and mental health services, oral health services, prescriptions, health-related social needs, and benefits for children and pregnant people.

There are many reasons why someone may need OHP. This includes people who are uninsured and have a lower income, and they may have sudden changes or loss of income.

They could have a life-threatening diagnosis. They could have a need for home or community-based services and intellectual or developmental disability, or substance use disorder, or none of these things, simply be in a situation where they are uninsured and need health care either to stay healthy or to become healthy.

OHP covers people with lower incomes. A single adult with an income of just above $22,000 or less per year, or a family of four with an annual income of around $45,000 per year would generally qualify. Oregon currently has 1.4 million Medicaid members, which means one in three people in our state are covered by Medicaid.

That’s 57% of children in Oregon. Half of births in the state are covered by Medicaid. Two out of every three nursing home residents rely on Medicaid. And counties in rural Oregon typically have higher Medicaid enrollment. 

So we have impact across the state and across folks in Oregon. When people can’t afford health insurance or are uninsured, they delay care until a situation becomes urgent. And if they do seek treatment, our health care providers and hospitals aren’t reimbursed, which increases overall health care costs for everyone, and leads to longer wait times in emergency rooms for everyone. 

Medicaid lowers health care costs by providing people with access to preventative care, which reduces the need for emergency services. Providing health care access to people can save money while ensuring access to care for people and families. 

So let’s talk about the federal changes after H.R. 1 was signed. We knew that keeping people covered would become more difficult.

What we’ve seen from other states that have more frequent, frequent renewals or work requirements for Medicaid is that the policies create real barriers to coverage. Instead of helping people, they add additional hurdles that make it harder for families to get the support that they need.

We don’t want to roll back progress or see people in Oregon putting off health care needs until it’s an emergency, or rationing prescriptions or care to get by. That’s what keeps us up at night.

The thought of people with chronic conditions with disabilities, kids with complex health needs, any person losing access to their prescriptions or health coverage suddenly due to missed paperwork.

So looking at the changes ahead for worker activity rules starting Jan. 1, 2027, some adults applying for or renewing ODB coverage will need to meet work or activity rules or show proof of an exemption when they renew their coverage.

About 600,000 adults will be evaluated for these new rules, and many are expected to qualify for exemptions, but they may need to provide proof. Oregon expects to receive more clarification and guidance from the federal government going into the next year.

But we know now what we know now about who may be exempt from work or activity rules is that people with serious health conditions, disabilities, some caregivers, pregnant individuals, those recently incarcerated and those already meeting SNAP and TANF work rules, may be exempt.

Exemptions also include people who are caretakers of children under 14 or someone of any age with a serious or disabling health condition. Folks who are American Indian, Alaska Native people who are pregnant or had OHP while pregnant in the last 12 months. Someone who was recently in jail or prison.

People who live in a county with a very high unemployment rate, high enough to get what they call an unemployment rate exemption. Folks who are traveling for a week or more away from home to get medical care.

People who are currently meeting a natural disaster exemption, those who are living in an area with a federal natural disaster, or people who are entitled to or receiving Medicare Part A or enrolled in Medicare Part B.

We know many people have urgent questions about exemptions, especially medical ones, and they’re not alone. States across the country are facing the same struggles and hearing the same concerns that we are.

In Oregon, we’re hearing from people in incredibly tough moments who are already scared and overwhelmed. There are people who are in the middle of lifesaving treatments and worried that their coverage might suddenly disappear.

There are parents unsure of who will care for their disabled child or family member when help is not available, and there are so many people working and eager to prove their hours in order to help keep healthcare within reach. 

These fears are real. We hear them and we want to provide as much information as possible so that people understand what is happening. 

We should be very clear. There are often assumptions about the people in our communities who rely on OHP. A majority of people in Oregon who are covered by OHP and can work already do. States that have implemented work requirements have not seen increases in employment, but they have seen people lose coverage because the reporting processes are difficult to navigate. 

The notices being sent out in the coming weeks will inform OHP members about the changes ahead. If you receive a notice, it does not mean that action is required immediately. You may need to provide additional information after Jan. 1 about worker activity rules. 

If you are new to OHP or when you’re up for renewal, we will let you know if that information is required. 

So what have we been doing to prepare? We understand that there are a lot of changes ahead, and we want to keep eligible people covered to the greatest extent possible. Immediately after H.R. 1 passed, Oregon started working quickly. We realized we had to work quickly, including the states that have been through these types of changes before or going through them. 

Currently, we’re learning from their experiences like trying to centralize information and roll out communications in phases instead of overwhelming members with too much information at once. 

We began preparing for the federal changes ahead, and in the last year, we’ve been working to design new technology systems to meet frequently with the federal government to define exemptions and rules and better understand these policies to reach out to partners, community members and advocacy groups. 

With more than 540 community presentations this year alone. This includes roundtables, community webinars, provider webinars, virtual trainings, meetings with hospitals and federally qualified health centers. And there’s more outreach to come because it’s so incredibly important to this effort. 

We’ve been training call center staff and OHP Assisters free helpers to guide OHP members. So far, 1,700 assisters have been trained across 400 community organizations across the state. We’ve been preparing outreach materials and have started providing toolkit information so that partners have shareable information to help keep members informed. 

We’re on the verge of posting a number of flyers, posters, and fact sheets on our toolkit site, and we’ll be encouraging community use of these resources. Our goal is to do everything possible to prevent eligible people from losing coverage, and that means making the process as simple as possible and then doing a good job of explaining it. 

Because health care processes can be confusing in the best of times, one of the most important things will be to have clear and consistent communications and messaging, and to let people know what is expected of them to get or maintain coverage, and to let people know that free help is available in their communities whenever they need it. 

Our goal today and in the months ahead, is to help OHP members understand what is changing, how they can keep their coverage, and where they can turn for support if they run into challenges. We also want partners and community members to understand how they can help us keep people covered. 

The most important thing that OHP members can do right now is keep their contact and case information updated so that they can receive information and notices from us. People can do that by going to benefits.Oregon.gov, or by calling 1-800-699-9075 or by visiting their local DHS office. As I mentioned, there’s also free help available through OHP assisters, and you can find that by going to Oregon.gov/gethelp and putting in where you live. 

More information about the changes ahead is available at the following website ohp.oregon.gov/hr1. Partners, providers, community members, and anyone else who’s interested in spreading the word about federal changes can find flyers, fact sheets, and other shareable information on OHA’s toolkit site.

We’ll have updated materials in that space throughout the next year, and I hope you’ll join me in getting the word out with one in three people in Oregon on OHP. We all know people who are on the Oregon Health Plan, especially in times of economic hardships. 

Making sure our neighbors have access to care is particularly important. When people can access care during a rough time, they can recover, get back to work, contribute to their community, or stay connected with the people around them. 

Accessible care isn’t just good for individuals. It keeps our neighborhoods steady, our local businesses strong, and our communities moving forward together.

Rebecca Hansen-White (KLCC) Hi, I’m Rebecca Hansen-White with KLCC and I had a timeline clarification question. So let’s say I was a person that that missed the notices or I provided information and I no longer qualified. I guess, what would be the timeline in 2027 to lose my coverage, if I wasn’t able to comply, or didn’t have the right information to prove I qualified?

Vivian Levy Thank you for that question. So people will be subject to the worker activity rules, people who are already on OHP, when they come up for renewal.

So for some people, that will happen throughout the year in 2027. And for some folks, it will not happen until the first part of 2028. So that process is actually going to happen over about 18 months. And so that’s why we say there are some people who will immediately feel the impact, but many people won’t feel the impact for quite some time.

But everyone is getting this notice that we’re sending out right now, who might be subject to the worker activity rules, letting them know that those rules exist. And so that’s part of what can be confusing is everyone’s going to get that notice right now, but folks won’t actually be subject to them until they go through their regularly scheduled renewal.

Kristine de Leon (Oregonian) This is Kristine de Leon with The Oregonian. Just to clarify, the notices are going to roughly 600,000 OHP members. That figure includes people who might be subject to the work rules, but then some of those people in the 600,000 might be exempt.

Vivian Levy That’s exactly right. We are required by the federal rules in H.R. 1 to send the notice to everyone who is potentially subject to them, even if we have information that they are exempt, or if we already have information that they meet the worker activity rules. 

So if you are a member and you’re working and you know that we know you’re working and you’re wondering why you got this notice, it is because we are required to send it to everyone regardless of that.

Max Sprague I see a question in the chat. Thank you, John Q from KEPW Whole Community News. The question, Vivian, is: The work requirement that can be met with 80 hours of volunteering. Are there requirements that we know of for nonprofit organizations receiving those volunteer hours?

Vivian Levy Thank you so much for that question. Yes, there are a few requirements which are also available on our website.

The organization cannot be considered to be politically affiliated, and there needs to be somebody at the organization who can help track and document the volunteer hours that the person accumulates over that time period. 

And there is more information and will be more information coming about how folks can document that and share that with us in the coming weeks.

Max Sprague Thank you. Emily Rogers from the Bend Bulletin, I see a question in the chat. How will these new federal changes uniquely affect rural communities?  I can speak a little bit to this (and Vivian, definitely fact-check me).

Rural communities in Oregon are unique even in the nation, right? We have these incredible—they’re beautiful, but we do have a lot of really unique geographic distances, right? 

So there’s the digital divide. Not everybody in rural communities has access to reliable internet, which is going to make submitting these requirements or submitting the things that we need them to submit more challenging. 

It may be that they have fewer options for healthcare. There are providers who primarily serve OHP populations who may be impacted. Same with CSOs. So we know that rural folks are really going to feel this. 

So that’s why we’re doing all that we can to work with partners, with community leaders. We’re making sure that we have materials that are accessible that can make it across those divides. We want to make sure we are reaching all across the state. It’s why we made sure that we had media from everywhere here today. And thank you very much for that. 

But we definitely know that rural folks are going to feel this in unique ways. Just to recap, if there’s anything that we want you to tell your readers, your audience members, your listeners, whoever, it’s that federal changes are coming to the Oregon Health Plan. 

Please keep your contact information up to date. Please make sure that, um, that you are staying connected with us. Visit our websites to connect with people who can help with you. Visit our call center. Continue to pay attention because these changes will come. 

But also we are going to be here to help. It is going to take all of us to make sure that people stay covered. 

And we are grateful to the providers, to the CEOs, to the community leaders, the legislators, the educators, our colleagues at DHS, everybody who is stepping up and reaching out to help every day. They are flooding my inbox. 

And honestly, this is not a surprise. This is who we are. This is what Oregon’s about. When wildfires spring up, so do mutual aid networks. First responders go door to door to warn people that a blaze is coming. 

And when it has passed, people come together to make sure that we are building something better, more innovative, stronger, that can help more people—because that’s who we are. 

We are proud to be your health authority, Oregon. Thank you for your time and for your care for yourselves and for each other. And you will hear from us soon.

Presenter The Oregon Health Authority prepares for new work requirements coming to Medicaid that were recently passed by Congress.