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Gov. Tina Kotek speaks at the Oregon state Capitol in Salem, Ore., Jan. 13, 2025.<\/p>\n
Kristyna Wentz-Graff \/ OPB<\/p>\n
Oregon Gov. Tina Kotek has quietly chosen a group of health care executives, union representatives and care providers to advise her on how to tackle the looming budget crisis in the state\u2019s Medicaid program. <\/p>\n
The group met for the first time Nov. 5 and will meet every two weeks. Its recommendations are due to the governor no later than July 2025. <\/p>\n
The group\u2019s work is inherently sensitive. Its charge, according to a charter document<\/a> provided to OPB, is to recommend changes to \u201cachieve sustainability\u201d in the state\u2019s Medicaid program as federal cuts kick in, while preserving access to critical services for the Medicaid population.<\/p>\n Health care policy experts told OPB some reduction in the benefits covered by Medicaid, known locally as the Oregon Health Plan, is likely given the state\u2019s budget woes. The group could also potentially identify new taxes or other sources of revenue to prop up the program. <\/p>\n Medicaid cuts from the Republican tax and spending bill, HR 1<\/a> (previously named the One Big Beautiful Bill Act) phase in over time starting in 2027, at the end of the state\u2019s current two-year budget cycle. Changes in the bill could cost Oregon<\/a> roughly $11.7 billion in federal funding over the following decade, according to the Oregon Department of Administrative Services. <\/p>\n OPB learned of the Medicaid workgroup last week and asked to attend its first meeting. The governor\u2019s office said the meetings are closed to the media and the public, citing an exemption in state open meetings law that allows some types of advisory groups<\/a> to meet privately. <\/p>\n Kotek declined to explain why it was necessary for the group to meet privately. <\/p>\n Medicaid is a taxpayer-supported program that provides health care to 1 in 3 Oregonians. <\/p>\n The advisory group has 18 members, according to a roster provided by the governor\u2019s office<\/a>. They come from all over the state and represent major financial stakeholders in the Medicaid program, including hospitals, doctors, dentists and labor unions.<\/p>\n Coordinated care organizations, which are local networks of doctors and insurers that contract with the state to run Medicaid, have the most seats in the group, with five CCO executives participating. <\/p>\n Also at the table is the Oregon Latino Health Coalition, the nonprofit that helped advocate for state-funded coverage for people in the country without legal status. <\/p>\n One notable omission: apart from the Latino Health Coalition, no consumer, disability or patient advocacy groups were chosen to participate. <\/p>\n Disability Rights Oregon, the state\u2019s leading advocacy group for people with disabilities, said they were not told about the closed-door group or invited to it. <\/p>\n Beth Brownhill, managing attorney at DRO, called the governor\u2019s lack of transparency \u201cappalling.\u201d <\/p>\n \u201cAny discussion about orchestrating Medicaid cuts that excludes people with disabilities and older adults is not only unjust, it\u2019s dangerous,\u201d Brownhill said. \u201cMedicaid isn\u2019t just insurance for our community. It\u2019s the difference between living independently or in an institution, between accessing life-sustaining medications and going without.\u201d<\/p>\n Lucas Bezzara, a spokesperson for the governor, said they will seek out additional perspectives as required to carry out the work. <\/p>\n The group\u2019s official charter is broad, but according to Bezzara, the group is intended to be nimble and narrowly focused on services budgeted for within the Oregon Health Authority. <\/p>\n The OHA oversees the Oregon Health Plan, which is essentially health insurance for people with little or no income. <\/p>\n A different agency, the Department of Human Services, manages some additional Medicaid-funded services and supports for people with disabilities and elderly adults. <\/p>\n \u201cNothing requires the Governor to pursue any recommendation produced. However, if any issues, learning or recommendations that may come from this group are pursued by the Governor, it will be weighed through a rigorous public process at that time,\u201d Bezzara wrote in an email. <\/p>\n Federal law requires state Medicaid programs to cover certain services<\/a>, like hospital care and most doctors\u2019 visits. <\/p>\n Other things that Oregon currently funds for Medicaid recipients without copays \u2014 including prescription drug coverage, dental benefits and hospice care \u2014 are not required by federal law. <\/p>\n Other stakeholders who weren\u2019t invited to participate said the governor\u2019s advisory group could be a promising start to tackling a thorny issue \u2014 but only if the group\u2019s work is limited as the governor claims. <\/p>\n As the executive director of NAMI Oregon, Chris Bouneff has been a longtime advocate for people with serious mental illnesses and worked with the governor last session on a high-profile civil commitment reform bill. <\/p>\n NAMI Oregon was also not offered a seat at the table, but that\u2019s not necessarily a problem, Bouneff said. <\/p>\n He noted that members of the advisory group have deep technical expertise in the Medicaid program. But a narrow group of financial stakeholders should not be making decisions, or crafting fully-baked policy, he said. <\/p>\n \u201cOne way to look at it is, this is not a very broad table. It\u2019s missing key perspectives,\u201d he said. \u201cIf they\u2019re going to make decisions and give advice to the governor, and the governor is not going to vet that advice more thoroughly, that would be a big mistake.\u201d <\/p>\n Bouneff added that behavioral health services are often cut during lean times, which concerns him. But Kotek, he said, has built up some goodwill. <\/p>\n \u201cShe\u2019s shown a real commitment to behavioral health,\u201d Bouneff said. <\/p>\n While the Medicaid workgroup\u2019s main focus is 2027 and beyond, its charter document also says the group may make recommendations for steps that need to begin in the current budget cycle. <\/p>\n Medicaid is one of the top line items in the state\u2019s budget, and Oregon\u2019s economy is showing signs of weakness<\/a>. Facing an immediate shortfall, Kotek and the legislature need to cut more than $300 million from the budget this year. <\/p>\n That\u2019s in the near-term. The long-term financial picture for Medicaid is much worse. <\/p>\n The cost of providing health care in Oregon has been increasing faster than it was before the pandemic, climbing well past a 3.4% growth target<\/a> set by the legislature for Medicaid. <\/p>\n And major cuts from the republican tax and spending bill will kick in starting in 2027. <\/p>\n
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