Oregon Medicaid director outlines program scope, recent 1115 waivers and expansion efforts

Emma Sandow, director of Oregon Medicaid, told the Senate Committee on Early Childhood and Behavioral Health Tuesday that Medicaid is central to state health policy and covers about 1.4 million people in Oregon.

Sandow summarized how Medicaid differs from Medicare and described Oregon’s delivery system, which uses coordinated care organizations or CCOs for roughly 92 percent of members and fee‑for‑service for about 7.5 percent (including some tribal members, youth in child welfare and certain other groups). She said coordinated care organizations receive a per‑member payment and are responsible for coordinating care and financial risk for their enrollees.

Sandow outlined Oregon’s use of Section 1115 waivers of the Social Security Act to expand coverage and benefits. She described two 1115 waivers in Oregon: a broad, long‑standing waiver the presentation referred to as the "big 1115 waiver," and a newer waiver focused on substance use disorder services. The waivers, she said, allow the state to test innovations such as health‑related social needs services (housing supports, food and air purifiers during wildfires), continuous enrollment for children ages 0–6 and a bridge/basic health program to reduce churn between Medicaid and the insurance exchange.

Sandow told the committee Oregon was the first state approved to implement continuous enrollment for children 0–6 and that the state recently extended coverage from one year to two years for people older than 6 to reduce churn. She also highlighted a new program launched in January to maintain certain services for young adults with special health needs when they age out of pediatric categories, a planned reentry benefit to cover services in the 90 days before release from incarceration, and new reimbursement authority to pay tribal partners for traditional healing practices.

Policy details Sandow cited included the federal matching formula (FMAP) and the requirement that 1115 waiver proposals be budget neutral to the federal government. She said Oregon’s total Medicaid program budget is large (Sandow cited roughly $29 billion per biennium) and noted that the federal share of the state’s Medicaid program is roughly 58 percent for the base program, with variation by eligibility group; for the Medicaid expansion adult group she referenced a roughly 90 percent federal match for those services.

Sandow described the Health Evidence Review Commission and the state’s transition away from a prioritized list mechanism that had placed some services below a coverage line; she said that federal rules and the waiver structure have changed how the state approaches coverage decisions and that the HERC will continue evidentiary review and coverage determinations.

Committee members asked about dual‑eligibles, the economic effects of waivers, remaining waiver implementation items and the prioritized list. Sandow said the state must show budget neutrality to obtain federal approval for waiver elements and described cost‑avoidance examples (for example, paying for an air purifier may be cheaper than repeated emergency department visits). She also said the state is in a learning phase on many demonstrations and remains focused on monitoring and improving program implementation.

Sandow closed by noting Oregon’s high coverage rate (she said roughly 97 percent of the state population has insurance and that about 3 percent remain uninsured) and directing members to OHA dashboards and resources for further data.

Ending: Committee members praised Oregon’s CCO model and coverage rates but reiterated that insurance coverage does not always equal access to timely care, particularly for behavioral health and some provider types.