In January of 2027, people on Medicaid will need to meet a slate of new requirements mandated by the One Big Beautiful Bill Act, or HR1. Some people on the Oregon Health Plan will need to confirm that they are working, volunteering or attending school every six months. And everyone will need to renew twice a year, rather than once every two years.
All this paperwork will be handled by the Oregon Department of Human Services, in collaboration with the Oregon Health Authority. Both departments are working hard to make sure they are ready for the January deadline.
Vivian Levy, Interim Medicaid Director for the Oregon Health Authority, and Nate Singer, Director of Eligibility Partnership at the Oregon Department of Human Services, join us to explain how Oregonians will be impacted.
Note: The following transcript was transcribed using AI and validated for accuracy, readability and formatting by an OPB volunteer.
Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. Big changes are coming to Medicaid. Starting in January, people on Medicaid will need to meet new eligibility requirements mandated by the One Big Beautiful Bill Act, or H.R. 1. Some people on the Oregon Health Plan will need to confirm that they’re working, volunteering or attending school every six months. Everyone’s eligibility will need to be renewed twice a year rather than once every two years.
Vivian Levy is the interim Medicaid director for the Oregon Health Authority. Nate Singer is the Oregon eligibility program director at the state’s Department of Human Services. They both join us now. It’s great to have both of you on Think Out Loud.
Vivian Levy: Thank you. It’s great to be here.
Nate Singer: Great to be here.
Miller: Vivian, before we get to the cuts and changes, I feel like for a little bit of table setting, can you just remind us how central the Oregon Health Plan is right now to the state’s overall patchwork of insurance and health care?
Levy: Absolutely. The Oregon Health Plan, which includes Oregon’s Medicaid program, covers over 1.4 million people in the state of Oregon, which is over a quarter of our population. A huge number of children are covered through Oregon Health Plan, over half the births in Oregon happen with mothers who are on Oregon Health Plan. Medicaid and the Oregon Health Plan, OHP, is really a huge component of the overall health care structure in Oregon.
Miller: And Medicaid enrollment, a recent report showed, has more than doubled in Oregon in the last 10 years. Does that mean that we’re going to be hit harder by Medicaid cuts?
Levy: It does mean that, because one of the huge drivers of that increase has been adults who fall into the categories that are most impacted by H.R. 1.
Miller: And what are those categories?
Levy: The policy that we’re going to be talking about today impacts people who are between 19 and 64 years old, who are not pregnant and are not on Medicare.
Miller: Can you describe what the new work requirements are?
Levy: So starting in January 2027, some adults applying for or renewing Oregon Health Plan coverage will need to meet work or activity rules or show proof of an exemption. Most adults who can work already do, but some will still need to provide documentation verifying that they are working. About 600,000 adults are gonna be evaluated for these new rules. Many are expected to qualify for exemptions, but again, they may need to provide proof. So even if they are exempt, they may need to do something or provide us with some information so that we have that information as part of their application.
For comparison, with SNAP work requirements, there were about 267,000 adults who needed to be reviewed. So, this is almost three times that number.
Miller: Nate, the last time we talked, it was about those new work requirements for SNAP benefits. And at the very end, I asked you one question about Medicaid, which was looming but that was not the focus of the conversation. We wanted to have you back because even though you work for a different state agency, the Department of Human Services, there’s been a lot of crossover to try to not have duplicative work on the part of various agencies. So just for the big picture here, what is DHS’s role going to be in terms of checking into eligibility for the Oregon Health Authority’s Oregon Health Plan?
Singer: The Oregon Department of Human Services, we do eligibility for the Oregon Health Plan, for SNAP, our food benefits. We do it for cash programs like Temporary Assistant for Needy Families, and for another agency, the Department of Early Learning and Care’s childcare programs. We do eligibility together to try to keep it coordinated, and we work across with the Oregon Health Authority on these areas.
So we will have the staff that will be taking the calls, meeting with individuals, doing those redeterminations, helping pull in the documents and making sure we have systems in place so hopefully, we can remove some of the burden that these additional administrative requirements have.
Miller: As Vivian noted, the population here is much bigger in terms of this new work requirement. Almost three times more adult Oregonians are going to have to be checked. But are the actual work requirements themselves the same as you’re doing for SNAP? Or are there differences that’ll complicate this?
Singer: There are differences as we look across this. Unfortunately, while it was one bill as it came through there, it wasn’t as coordinated as a state would like to see in implementing it. So we’re able to take lessons learned that we have from SNAP in doing things, but the requirements in other ways aren’t going to line up. There’s a lot of opportunities – and Vivian can share some of these – where if we can show you’re already meeting requirements or doing things for SNAP, we can automatically exempt you for Medicaid. So we’ll be trying to do all we can again to process this as effectively as we can with these additional requirements. But unfortunately, they’re just different programs.
Miller: You mentioned there have been lessons learned. What have you learned so far from administering the SNAP work requirements that can be applied to Medicaid?
Singer: What we know from SNAP is that if we can communicate clearly and reduce administrative burden, people are much more successful. So that’s exactly the approach we’re trying to take with Medicaid work requirements. We know people are working, they’re raising their families, they’re juggling a lot of responsibilities, and they don’t have time to wait on hold or stand in line just to understand what we need them to do, or now the federal government’s requiring us to ask of them.
So that’s why we’re really investing more time in trying to make our notices clear, making sure there’s going to be text messages, online self-service options, a mobile app, and really new technology to help answer questions. Because we know those approaches have helped people take actions for SNAP, and so we’re trying to build that at the beginning with Medicaid work requirements.
I would just note that the last thing from lessons learned is, as an agency, our responsibility is to try to reduce the administrative burden whenever we can. In SNAP, we’re continually looking for ways to verify information ourselves before asking people to provide paperwork. So that same principle is what was guiding our Medicaid work. If we can verify information for someone, we should. People should focus on their jobs, their families, not gathering documents for the state. We’re using technology like consent-based data sources to carry out as much administrative burden as possible and only asking people for documents when there’s no other way to verify the information.
Miller: Does that mean that your hope is that in some cases, or maybe in many cases, you’ll be able to do this re-verification for eligibility without current Medicaid recipients even knowing that they have been re-verified? It’ll just happen in the background and then they will maintain their health insurance?
Singer: Vivian, if you want to share a little bit more around some of the numbers and what we’re hoping to see on this, and then I can add a little bit more around what we’re hoping how it’d look.
Levy: So, what you described is always our goal when we’re renewing coverage for people on Oregon Health Plan. We always want to use all of the information that we have available and try to automate the process as much as possible, so that, as you said, we can realize someone needs to have their coverage renewed, use the information and the data that we have to verify it, and then just let them know, “Hey, you’re still eligible.” We still will have the ability to do that, but with these more complex requirements, it increases the likelihood that we may not have the data available in order to show that somebody is eligible, and there will be a greater likelihood that we will need to reach out to folks to get that additional information. So we’re going to continue to do that as we have been, but we do expect that we will be able to do it in fewer cases and that in more cases, people will have to provide us with additional information.
Miller: Well, you did note that most adults who are on Medicaid now who can work, are working. If that’s the case, what’s your best estimate for the number of Oregonians who will lose their eligibility as a direct result of these new requirements?
Levy: The data shows that there’s a risk that between 100,000 and 200,000 adults could end up losing coverage as the result of this new policy. And again, that is not as a result of not meeting the eligibility requirements. That’s a result of a very complex and difficult-to-understand process as a result of these new requirements. The more complicated the requirements get, the more complicated the process gets. And as Nate noted, people have whole lives that they need to interact with and maintain outside of just maintaining their OHP eligibility. So the risk of losing people along the way in the process increases a lot with this complexity.
Miller: Losing Medicaid does not magically mean that people aren’t going to get sick or need health care. It just means that if they do get care that this federal-state partnership of insurance won’t pay for it. Let’s say that the upper end of that estimate that you just mentioned, it turns out to be the number of people who lose their Medicaid coverage because of this, 200,000 adults. What would that mean for Oregon’s health care system as a whole?
Levy: When large numbers of people lose health coverage, it creates ripple effects across the entire health care system. As we talked about earlier, OHP is a huge part of that health care system here in Oregon. Oregon could lose between $718 million and $1.4 billion in federal Medicaid funding each year. That’s between $8 [billion] and $16 billion in federal funding over a decade that would not be coming into Oregon. But as you stated, those folks would still be seeking care and often seeking care in less ideal situations like the emergency room, which we know are much more expensive and suffer from overcrowding already. So both the financial impacts and the impacts to the use of the health care system could be impacted greatly by that kind of loss.
Miller: Vivian, we’ve been focusing so far on eligibility and Medicaid roles, but this is just one huge issue the state has been facing in terms of Medicaid. Another is the massive budget cuts that are looming. You’re gonna have to trim something like $420 million for the coming biennium, and then twice that by 2029. What’s on the table right now?
Levy: We have a huge challenge in front of us. Governor Kotek convened the advisory group to the governor on Medicaid sustainability, to try to really understand the impacts of H.R. 1, with the goal of sustaining Oregon’s Medicaid program. So, that advisory group was tasked with figuring out how to lessen the impact of these large federal reductions, while preserving the core tenets of the Medicaid program that we deliver through Oregon Health Plan.
That advisory group operates independently, and they just completed their report and sent it to the governor. That report is part of the planning process for putting together the governor’s recommended budget in the late fall and really putting together a blueprint for how we’re going to tackle these budget impacts.
Miller: But they didn’t come out with their own recommendations. They had 40 different options for reducing spending, but they didn’t say you should do A, B and C.
Is it fair to say broadly that the three big levers that a state has to lower overall Medicaid costs are 1) Reducing the number of people on the plan, 2) Reducing what’s covered, or 3) Reducing how much you’re reimbursing providers for those services? Those are the three big ways to find some extra dollars here and there?
Levy: Yes, broadly. And certainly, none of those are easy topics to tackle. And that’s one of the reasons there are so many different options and avenues to explore.
Miller: Well, can you give us a sense for what you think this is going to look like when all is said and done? How the state, even just for the coming biennium … which is ridiculous to say, but it’s half a billion dollars is the easier one of the cuts comparing it to three years from now. But what might we expect?
Levy: I think that one of the things that you can always count on in health care is that there are going to be massive challenges and massive opportunities to figure out how to step back and do things differently. I think that there are going to be hard decisions that need to be made to ensure that we can maintain the quality of care and the level of care that we deliver through the Oregon Health Plan. We’ve seen many, many changes over the years with Medicaid, and our job as a state is to weather those changes and to continue to be nimble and creative in thinking about how we operate within this much larger federal health care system, and all of the complexities there. So I think we’re going to have a lot of challenging conversations, because there are no easy answers here.
But I do know that Oregon is a state where we believe that ensuring that people can access health care regardless of income is one of our core values, and that’s what we’re going to hold at the middle of considering any of these different options.
Miller: Just briefly, the Healthier Oregon program offers Medicaid to undocumented people living in Oregon. It cost the state over a billion dollars in the previous biennium, and the majority of this money comes from the state, as opposed to the feds. That’s the reverse for other populations. Is this program potentially on the chopping block?
Levy: This program is an integral part of the Oregon Health Plan, going back to our core value of ensuring that all people have access to health care regardless of income. The Healthier Oregon program is a way of ensuring that we are making good on that commitment, and that Oregon Health Plan, as part of our larger health care system, is ensuring that everyone is able to seek the care that they need in the most appropriate setting and the most cost-effective setting, so that we can all have a healthier population in our state. That’s what we’re focusing on with Healthier Oregon, and we are moving forward for our entire Oregon Health Plan membership to deliver the very best care that we can.
Miller: Vivian Levy and Nate Singer, thanks very much.
Levy: Thank you.
Singer: Thanks.
Miller: Vivian Levy is the interim Medicaid director for the Oregon Health Authority, Nate Singer is the Oregon Eligibility program director at the state’s Department of Human Services.
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