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Oregonians with incomes over 138 percent of the federal poverty level who earn too much to qualify for expanded Medicaid, who are also without employer paid health insurance, are in a coverage gap.

New Federal Medicaid/Medicare Standards

In 2014, the Oregon Center for Public Policy estimated that about 120,000 Oregonians who must get health insurance or pay a fine would remain uninsured by 2019. Of that group, nearly half would be low-income people with incomes below 200 percent of the federal poverty line who earn too much to qualify for expanded Medicaid under the Oregon Health Plan.

Oregon is not the only state experiencing this coverage gap. To address the problem, in March 2014 the Center for Medicare and Medicaid Services (CMS) established standards for the Basic Health Program, allowing states to access federal funds to establish alternative subsidy programs for low-income individuals who don’t qualify for expanded Medicaid coverage.

In January 2016, New York State made an official request for certification of its Basic Health Program. In April of that same year, the state of Minnesota also applied for certification.

Oregon Presents Study Report to Legislature

In 2014, the US Department of Consumer and Business Services, in collaboration with the Oregon Health Authority (OHA), and in consultation with a stakeholder advisory group, presented its “Oregon Basic Health Program Study” report to the Legislature.

Once established, Oregon’s Basic Health Program would be an affordability program (IAP) offering coverage in place of Marketplace coverage at a much lower cost for those with incomes from 138 to 200 percent of the federal poverty level. Under this program, a three person household with a combined income of up to $40,180 would qualify for coverage. Similarly, a two person household earning up to $31,860 would qualify for coverage and a single person household earning up to $23,540 also would qualify.

The Basic Health Program established by the Affordable Care Act through the Center for Medicare and Medicaid Services (CMS) also provides an opportunity to expand coverage to those above 200 percent of the poverty level still uninsured and to offer more affordable premiums and cost-sharing for low-income residents.

To apply for the Oregon Health Plan go to http://healthcare.oregon.gov/Pages/apply-renew.aspx.