Building an Organizing and Advocacy Model for Self-Direction
This model discusses the importance of community organizing and advocacy in improving self-direction. It highlights the challenges faced in New York's CDPAP program and emphasizes the need for impactful advocacy strategies to address public issues. Through defining organizing and advocacy, it offers insights on setting agendas and targeting communities effectively to drive positive change.
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Presentation Transcript
CCO Operations Collaborative December 14, 2021 Dave Inbody CCO Operations Manager Oregon Health Authority The meeting will begin momentarily
Agenda Agenda Item Item Presenter Welcome & Announcements Medical Coverage Changes Experimental Services CCO 2.0 Progress Assessment Dave Inbody Sexual Orientation & Gender Identity (SOGI) CCO 834 Data Shawna McDermott Cover All People Hope Glassberg 2
Welcome & Announcements Medical Coverage Changes Experimental Services CCO 2.0 Progress Assessment
Context for SOGI CCO-834 Data Shawna McDermott; former CCO Services Manager; Behavioral Health Operations Director Health Systems Division
SOGI Questions in ONE Application Pre-July 2020 Paper Application CCO OPERATIONS Health Systems Division 5
SOGI Questions in ONE Application April 2021 Paper Application CCO OPERATIONS Health Systems Division 6
IE ONE to MMIS to CCO Sex assigned at Birth data is currently mapped to MMIS/EDI/834 ONE Application choices are Male or Female Unknown is not a choice Claims for a gender-associated surgery or therapy sometimes require a workaround modifier for claims processing because the gender in MMIS does not align to sex assigned at birth. CCO OPERATIONS Health Systems Division 7
IE ONE to MMIS to CCO Gender Identity data is solely housed in ONE,there is currently no transfer/mapping to MMIS/EDI/834 It is also important to note that the current way that gender identity is asked about on the ONE application is outdated and will need to change; near-term and long-term changes are expected Recent passage of HB 3159 (REALD & SOGI) will result in future data collection investment, including a REALD Data Repository developed by OHA s Health Policy & Analytics Division OHA s Office of Equity and Inclusion has engaged a Sexual Orientation and Gender Identity (SOGI) Data Collection Workgroup for the past few years; this group has been developing a set of proposed data collection standards that need go thru a rulemaking advisory process per HB 3159 The MMIS team will be coordinating the values that ONE will be using in their system (as an outcome of HB 3159); once we get to the point of this data being transferred/mapped to MMIS, the values will not be HIPAA compliant and the 834 will place these new values in the 2750 loop. CCO OPERATIONS Health Systems Division 8
HB 3352: Cover All People Update Stephanie Jarem, MA, MPH, Director of the Office of Health Policy, OHA HEALTH POLICY AND ANALYTICS DIVISION
Goals for today Overview of Cover All People legislation Status update on OHA and ODHS planning and eligibility decisions so far Collect your questions with a plan to return in January to continue the discussion 10 10 10 10 10
HB 3352: Cover All People HB 3352, or Cover All People (CAP), aims to provide full Oregon Health Plan benefits to adults residing in Oregon who would otherwise qualify for medical assistance except for their immigration/citizenship status. OHP coverage starts July 1, 2022. $100 million General Fund expenditure cap on the overall program costs for the 2021-2023 biennium. 11 11 11 11 11
HB 3352: Cover All People Maximizing Dollars The Oregon Health Authority, in collaboration with the Department of Consumer and Business Services, if necessary, shall seek any federal approval or waivers of federal requirements necessaryto maximize federal financial participation in the costs of providing medical assistance to adults in the Cover All People program established in ORS 414.231. OHP coverage will supplement existing federal funding that covers medical emergencies for some uninsured individuals (CWM) to provide a full benefit package. 12 12 12 12 12
HB 3352: Cover All People Advisory Work Group In September, OHA convened an Advisory Workgroup (AWG) of community members and advocates to develop options and strategies to prioritize enrollment of groups while maintaining spending within current legislative appropriations. In addition to program design, the AWG will also create recommendations to expand existing outreach, engagement, and education efforts and will develop new strategies. 13 13 13 13 13
Initial Eligibility The Advisory Workgroup voted to recommend that beginning July 1, 2022, OHA provide full OHP health coverage to people who are 19-25 years old and 55 years and older who are not currently eligible for full OHP benefits because of their immigration status. 14 14 14 14 14
Advisory Workgroups Path to Covering All People 15 15 15 15 15
Cover All People Timeline September December 2021 Advisory Workgroup develops Cover All People program design December 2021 Initial program design finalized January March 2022 Advisory Workgroup helps to develop Outreach, Engagement, and Education strategies January June 2022 ODHS and OHA implement systems changes April 2022 Outreach, Engagement, and Education efforts begin July 1, 2022 Coverage begins 16 16 16 16 16
Next Steps 1. Collect your questions about the program today. 2. Staff will return in January meeting to continue the conversation. 17 17 17 17 17
Questions? 18 18 18 18 18
