Securing another federal Medicaid waiver — which could mean $1.25 billion for Oregon over five years — before President-elect Donald J. Trump takes office is a high priority for Gov. Kate Brown, according to text messages between the governor and her chief of staff.
Approval of the waiver would have significant effects on state budgeting and health care options for low-income Oregonians on Medicaid.
Waivers allow states to pursue innovative health care policies. They're also subject to federal approval. Oregon has used its waivers to bolster coordinated care organizations (CCOs) — networks of health care providers that agree to serve Medicaid enrollees.
"I know you are in executive team, but we need to get the OHP waiver before the next administration comes in," Brown texted to her chief of staff, Kristen Leonard, referencing the Oregon Health Plan, the state Medicaid program.
Leonard responded: "It is top of our list on the white board already. We are calling together a meeting of the team this afternoon to figure out an urgent game plan."
The messages were sent the morning after the Nov. 8 election, records show. They were released to the Statesman Journal via public records request.
The Oregon Health Plan serves 1.1 million people, according to the Oregon Health Authority.
So far, there is no indication the waiver application will be fast-tracked for approval before President Obama leaves office. Federal officials told the state in September they hope to work through most of the application before year's end, but gave no guarantee.
Andy Slavitt, acting head of Centers for Medicare & Medicaid Services, the federal agency that processes Medicaid waivers, visited Oregon this month to see a state CCO in person. He issued a statement at the time saying he is "impressed" with Oregon's work under the waiver and wants to see it continue.
CMS said Wednesday it is continuing to work with Oregon on its waiver renewal.
That sentiment was echoed by a spokeswoman for Brown, who said the state has "worked closely" with federal authorities and has had "positive conversations" about the waiver application.
A waiver has been in place since the Oregon Health Plan went active in 1994. The current one is set to expire in June 2017. Gov. John Kitzhaber negotiated that deal, which brought in $1.9 billion over five years.
Landing another Medicaid waiver would alleviate part of Oregon's projected budget deficit. The waiver is estimated to be worth $1.25 billion over five years. The state is facing a two-year $1.4 billion deficit.
Jeffrey Newgard, who lobbies the Oregon Legislature for health care organizations, said approval of the waiver "makes budgeting considerably easier." Without the waiver and attendant federal funds, the state would need to consider cutting its Medicaid offerings.
If the waiver isn't approved, the Trump Administration could still fundamentally retool Medicaid in Oregon and nationwide.
Adding pressure to state officials is uncertainty posed by Trump's recent choice for Health and Human Services secretary — Rep. Tom Price, a Georgia Republican who has vowed to dismantle Obamacare and indicated support of restructuring Medicaid. Vice president-elect Mike Pence told a meeting of Republican governors Nov. 14 that Trump supports replacing Medicaid's funding mechanism with block grants.
Health Authority spokeswoman Courtney Warner Crowell said it's too early to tell what the long-term effects on Medicaid may be. "There will be a lot of speculation in the next couple of months," she said.
Renewal of the waiver would come as a sigh of relief to health care advocates. Many have lauded CCOs for their focus on preventative medicine. Retiring Rep. Peter Buckley, D-Ashland — a key figure in state budget politics — has cautioned the governor against putting CCO funding in jeopardy in a private meeting.
Brown is scheduled to release a balanced budget proposal Thursday.
Full statement from Melissa Navas, spokeswoman for Gov. Kate Brown:
The Governor and state remain committed to ensuring all Oregonians have access to high-quality, affordable health care.
Governor Brown has made continuing Oregon’s health care transformation momentum a top priority, and Oregon has worked closely with federal partners on its waiver renewal since last spring.
The current five-year waiver does not expire until next summer.
We continue to have positive conversations with CMS about the waiver renewal and will continue to work with them to find a path to do so.