Health plan kickoff clause going.

Byline: David Steves The Register-Guard

One of the most controversial changes to the Oregon Health Plan - kicking poor people off the plan if they missed a monthly premium payment - is going away.

An e-mail sent out by the Department of Human Services on Wednesday said it would drop that policy, based on having received verbal approval of the change by federal regulators.

The changes were ordered under a bill approved last summer by the state Legislature, but put on hold until approved by the Centers for Medicare and Medicaid Services, which governs how states spend federal health care dollars.

Starting June 1, the poorest of those eligible for the "standard" version of the plan - those with income of no more than 10 percent of the poverty level - will be exempt from paying monthly premiums beginning June 1. These Oregonians make up about 9,000 of the 21,000 people on the OHP standard version. For a single adult, just less than $82 of monthly income represents 10 percent of the poverty level. Their premiums have been $6 a month.

Those with income above that 10 percent mark will continue to be charged premiums. But starting June 1, they no longer will be disqualified from coverage if they miss a monthly premium payment, said Roger Staples, acting special projects manager with the Oregon Medical Assistance Program.

Instead, they will continue on the plan, but must pay past-due premiums at the end of their six-month enrollment period before renewing.

For OHP Standard enrollees in this category, the premiums range from $9 to $20 a month per patient, depending where their income falls on a sliding scale from more than 10 percent to 100 percent of the federal poverty level. For a single person, that ranges from $82 to $817 a month.

Health care advocate Ellen Pinney lobbied the 2005 Legislature to drop its previously adopted premium payment rules. She and others predicted that the payments would prove too punitive, and says the record backs her up.

"We have maintained since the beginning that imposing premiums on this population was going to result in massive disenrollment, and that it was inequitable and punitive," said Pinney, executive director of the Oregon Health Action Campaign.

From late 1995 through 2002, the health plan required premium payments, but did not disqualify those who missed payments and let them catch up past debt every six-month renewal period, Staples said. In addition, it waived the premiums if enrollees met any of a half-dozen criteria, such as being homeless or a domestic violence victim.

The new rules come closer to that old system, although it doesn't waive payments for those with income above 10 percent of the poverty level.

"One might think we're going back to what we used to have," he said. "But it doesn't quite do what it did in the past."

Pinney said ideally, the state would not charge any premiums from people living in poverty, since she doesn't think poor people should choose between paying for their health care, for food or for shelter.

Under the current premium-payment system, those who are kicked off the plan for failing to make payments cannot reapply for six months. But in reality, they have been essentially banished from the plan, since the state stopped admitting new enrollment during the budget crisis early this decade.

Pinney said the premium payment requirements are by far the biggest reason enrollment in the standard version of the Oregon Health Plan plunged from 109,000 in 2002 to its current 21,000 enrollment.

When the Legislature was debating the 2003 payment requirements, those who supported the changes argued they would ensure a sense of responsibility among patients. Pinney said that's not what the changes were really all about.

"It wasn't about making people feel responsible for their health care," she. "It was about getting people off the plan. And it worked."