Medicaid at 50 Reaches More Pre-Medicare Residents

By Merry MacKinnon

Five years ago, when Kathleen McCann lost her job and her employer-provided health insurance, she joined others in their 50s and early 60s hoping to get by until Medicare kicked in.

Many older adults who were laid off during the recession were calling AARP Oregon. “We were hearing ‘Help!’ from people caught in limbo,” said Jerry Cohen, AARP Oregon state director.

After exhausting her unemployment benefits and temporary health coverage, McCann could no longer afford to see her primary care provider, the one who had diagnosed her type 2 diabetes and had been monitoring her fibroid tumors.

“I put off going to the doctor,” said McCann, of Portland, an experienced office assistant who looked for work for two years. “I kept my fingers crossed.”

While uninsured, McCann had some troubling symptoms that led her doctor to refer her to a local women’s clinic. There, a doctor recommended a precautionary hysterectomy.

McCann got an appointment through a hospital’s program for low-income patients. But then an ultra­sound revealed tumors in her abdomen and bladder that were diagnosed as stage 3 cancer.

In April 2014, her Medicare kicked in, and on her 65th birthday, McCann spent seven hours in surgery. Nineteen weeks of chemotherapy followed.

Expansion’s impact
With a monthly income below the state’s eligibility standard of $1,354, McCann also qualified for Medi­caid, becoming one of more than 68,000 dual-eligible Oregonians.

McCann said that without Medi­caid to close Medicare gaps, she would be overwhelmed by hospital, doctor and prescription drug bills. “I’m grateful,” she said.

Oregon greatly expanded access to Medicaid coverage, called Oregon Health Plan, under the Affordable Care Act in 2014. As the Medicaid program marks its 50th anniversary this month, it’s now reaching more than 1 million of the state’s nearly 4 million residents, up from 655,000 enrolled in 2013.

More than 57 percent of those enrolled are nondisabled adults, and about 41 percent are children. About 81,600 are adults and children with disabilities. Approximately 216,000 are “pre-Medicare” adults 50 and older.

The current Medicaid budget is about $13.3 billion over two years, with federal funds accounting for about 70 percent of that total.

A lot of behind-the-scenes bipartisan work smoothed the way for Medicaid expansion, Cohen said. “One challenge in the future will be the large increase in the number of persons with lifelong disabilities living to old age. A blessing, but also one requiring increased funding.”

With more older Medicaid recipients, Oregon has been focusing on controlling costs by keeping older beneficiaries and people with disabilities in their homes and communities with support services, instead of institutional care.

“This has enabled Oregon to serve a larger number of eligibles with minimal impact on the state budget,” said Chad Cheriel, 72, of Portland, AARP volunteer state president and a former long-term care services researcher and administrator.

Efforts to contain costs may depend on Oregon’s experiment with coordinated care organizations, or CCOs. Backed by federal funding, 16 regional CCOs enlist teams of medical, mental health and dental care providers who collaborate on patient-focused care.

Oregon received a $1.9 billion, five-year federal grant for the program. In return, the state must reduce the growth of health care spending by 2 percent without diminishing the quality of care. The Oregon Medical Association supports the approach.

“CCOs are unique to Oregon,” said Stephanie Tripp, spokeswoman for the Oregon Health Authority.
A National Institutes of Health study is evaluating the CCOs. “The way it’s set up makes Oregon’s coordinated care organizations the most ambitious attempt to control costs,” said lead investigator John McConnell. He is also director of the Oregon Health & Science University Center for Health Systems Effectiveness.

Merry MacKinnon is a writer living in Portland.