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Medicaid programme changes and the chronically ill: early results from a prospective cohort study of the Oregon Health Plan

Portland Veterans Affairs Medical Center, 3710 SW US Veterans Hospital Road, Portland, OR 97207, USA

Jennifer Devoe

Department of Family Medicine, Oregon Health & Science University, FM, 3181 Sam Jackson Park Rd, Portland, OR 97239, USA

Bill J. Wright

Providence Health System Center for Outcomes Research, 5211 NE Glisan, Portland, OR 97213, USA

Jeanene Smith

Office for Oregon Health Policy and Research, 800 Oregon Street, Room 607, Portland, OR 97232, USA

Janne Boone

Office for Oregon Health Policy and Research, 800 Oregon Street, Room 607, Portland, OR 97232, USA

Tina Edlund

Office for Oregon Health Policy and Research, 800 Oregon Street, Room 607, Portland, OR 97232, USA

Matthew J. Carlson

Portland State University, PO Box 751, Portland Oregon 97207, USA, carlsonm{at}pdx.edu

Objective: To describe the impacts of recent Oregon Health Plan (OHP) policy changes on individuals living with chronic illness in Oregon.

Methods: A mail survey was conducted of 1374 OHP beneficiaries who were directly affected by the new policies. The analyses reported in this article represent baseline findings from the first of three survey waves in an ongoing prospective cohort study.

Results: A significant association was found between Medicaid policy changes and high rates of disenrolment from the OHP. Compared to the non-chronically ill, the chronically ill were more likely to report inability to pay for medications, higher medical debt, more unmet health needs, and poorer health status. Among the chronically ill, those who lost insurance reported decreased access to and utilization of healthcare, more medical debt, and more restriction of medications.

Discussion: As policy-makers restructure public programmes to accommodate tight budgets and rising healthcare costs, people with chronic illness can easily be overlooked. Chronically ill individuals face disproportionate financial and health burdens. Small cost-saving policy changes can lead to widespread disenrolment that cascades into reduced access to healthcare services, altered utilization patterns, and financial strain.

Key Words: Medicaid • Oregon Health Plan • Health services accessibility • Chronic disease • Cost sharing • Medically uninsured

Chronic Illness, Vol. 1, No. 3, 191-205 (2005)
DOI: 10.1177/17423953050010030301


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