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Oregon Covering Kids Families State of Oregon Department of Human Services Oregon Health Plan

Aim Statement. To reduce the

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Oregon Covering Kids Families State of Oregon Department of Human Services Oregon Health Plan

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    1. Oregon Covering Kids & Families & State of Oregon Department of Human Services Oregon Health Plan Oregon Health Plan (OHP) Central & the Rogue Valley Covering Kids & Families Collaborative

    2. Aim Statement To reduce the “pend” rate for Oregon Health Plan applications by 15%. Pended Applications Nov 02 – 8,308 Dec 02 – 9,495 Jan 03 – 8,515 Feb 03 – 9,233 Mar 03 – 11,305 Apr 03 – 12,381 May 03 – 11,374 Jun 03 – 10,152 Jul 03 – 8,125 Aug 03 – 7,924 Sep 03 – 8,278 Oct 03 – 8,101 Average = 9,433 apps monthly Or 47% of the applications approved or deniedPended Applications Nov 02 – 8,308 Dec 02 – 9,495 Jan 03 – 8,515 Feb 03 – 9,233 Mar 03 – 11,305 Apr 03 – 12,381 May 03 – 11,374 Jun 03 – 10,152 Jul 03 – 8,125 Aug 03 – 7,924 Sep 03 – 8,278 Oct 03 – 8,101 Average = 9,433 apps monthly Or 47% of the applications approved or denied

    3. Who Are We? The Oregon Health Plan, a Medicaid demonstration, was implemented February 1994. OHP Central is a centralized processing center located in Salem, Oregon, receiving an average of 18,000-20,000 OHP applications monthly from around the state.

    4. Who Are We? Cont.. OHP Processing Center is a high production unit which determines eligibility for 70% to 75% of all the OHP Medicaid applications for the State of Oregon. Oregon Health Access Project is the Oregon state lead agency for the RWJF Covering Kids & Families Initiative.

    5. Oregon Health Plan Processing Center OHP has 6 regional teams. Specialized phone bank to answer incoming inquiries. Point people to process applications for DV victims and/or pregnant women. Specific teams to process Self Employment and MAA/MAF applications. Exceptional training team with a commitment to success for each employee.

    6. Partnership with Rogue Valley CKF in Jackson County RWJF Covering Kids and Families (CKF) grant was awarded to: Oregon Health Access Project (CKF lead agency for Oregon). Local CKF Pilot: Rogue Valley CKF, Jackson County.

    7. Partnership Cont.. Southern Oregon is a rural area populated with a high number of low income Oregonians. From the July 1, 2003 preliminary estimates show there are 3,541,500 Oregonians. The population in Jackson County is 189,100 or 5% of the overall population.

    8. Project Team Collaborative members include: LoriAnn Sheridan, Tim Miller, Michele Wallace and Lisa Hendricks. OHP Central Project Members include: Carlie Jackson, Randi Burckhardt, Karen House and Sheila Tolleson. Beginning November 1, 2003, OHP has 2 dedicated staff to determine eligibility and track data from randomly assigned applications.

    9. What we will track..

    10. Baseline Statistics OHP Applications Received: Nov 02 – 20,135 Dec 02 – 18,973 Jan 03 – 21,111 Feb 03 – 20,794 Mar 03 – 19,505 Apr 03 – 18,670 May 03 – 16,621 Jun 03 – 16,814 Jul 03 – 17,312 Aug 03 – 16,713 Sep 03 – 18,458 Oct 03 – 18,740 Average: 18,654 apps received monthly.OHP Applications Received: Nov 02 – 20,135 Dec 02 – 18,973 Jan 03 – 21,111 Feb 03 – 20,794 Mar 03 – 19,505 Apr 03 – 18,670 May 03 – 16,621 Jun 03 – 16,814 Jul 03 – 17,312 Aug 03 – 16,713 Sep 03 – 18,458 Oct 03 – 18,740 Average: 18,654 apps received monthly.

    11. Stats Cont.. Applications Approved & Denied Nov 02 – 13,363 & 7,680 Dec 02 – 13,268 & 7,591 Jan 03 – 13,746 & 7,541 Feb 03 – 12,824 & 7,335 Mar 03 – 13,142 & 7,789 Apr 03 – 13,979 & 8,004 May 03 – 14,299 & 8,365 Jun 03 – 12,988 & 7,240 Jul 03 – 11,594 & 5,517 Aug 03 – 12,097 & 5,322 Sep 03 – 12,596 & 5,388 Oct 03 – 12,522 & 5,560 Average Approved = 13,035 or 65%. Average Denied = 6,944 or 35% Applications Approved & Denied Nov 02 – 13,363 & 7,680 Dec 02 – 13,268 & 7,591 Jan 03 – 13,746 & 7,541 Feb 03 – 12,824 & 7,335 Mar 03 – 13,142 & 7,789 Apr 03 – 13,979 & 8,004 May 03 – 14,299 & 8,365 Jun 03 – 12,988 & 7,240 Jul 03 – 11,594 & 5,517 Aug 03 – 12,097 & 5,322 Sep 03 – 12,596 & 5,388 Oct 03 – 12,522 & 5,560 Average Approved = 13,035 or 65%. Average Denied = 6,944 or 35%

    12. Stats Cont… OHP Caseload (Branch 5503 only) Nov 02 – Data not Available Dec 02 – Data not Available Jan 03 – 78,799 Feb 03 – 78,054 Mar 03 – 75,369 Apr 03 – 75,718 May 03 – 69,135 Jun 03 – 69,148 Jul 03 – 68,997 Aug 03 – 64,788 Sep 03 – 63,975 Oct 03 – 65,124 Average 5503 Caseload monthly = 70,911. OHP Caseload (Branch 5503 only) Nov 02 – Data not Available Dec 02 – Data not Available Jan 03 – 78,799 Feb 03 – 78,054 Mar 03 – 75,369 Apr 03 – 75,718 May 03 – 69,135 Jun 03 – 69,148 Jul 03 – 68,997 Aug 03 – 64,788 Sep 03 – 63,975 Oct 03 – 65,124 Average 5503 Caseload monthly = 70,911.

    13. Possible Targets for Improvement Oregon has requested and is waiting for CMS waiver approval on the following amendments: The OHP application is being revised to incorporate the 7211 addendum. Expansion of coverage for the State Children’s Health Insurance Program from 185% to 200% of the Federal Poverty Level.

    14. Possible Targets Cont… Redefinition of the Standard Benefit Package. Include RX Drugs, Outpatient Mental Health and Chemical Dependency Services. Emergency Dental Services Eliminate delayed eligibility start date.

    15. Oregon Covering Kids & Families & State of Oregon Department of Human Services Oregon Health Plan Thank You!

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