Plan Design committee March 2025 update
The Plan Design and Expenditures Committee of the UHPGB met for the fifth time on March 6, 2025.
Summary by Sandra Coyner, HCAO/HCAO-Action (SandraCoyner@hcao.org)
The Committee had substantial discussions of four topics:
Long Term Supports and Services (LTSS). Currently Medicaid provides better benefits for LTSS than PEBB does. The Board favors an approach for the new Universal Health Care that will retain these benefits for those who would be eligible for Medicaid, including meeting tests for very low levels of income and assets. Private insurance coverage for LTC could continue. Additionally, the Committee will recommend that some kind of new Task Force be set up independent of this PD&E Committee to explore additional option(s).
Behavioral Health (BH). Substantially approved a list of BH services that would be provided in the new universal system, and a list of provider types that could be reimbursed. Aim is to be comprehensive of what works.
Eligibility. Discussed who is “resident,” how that will be determined, and various tricky cross-border issues, including people who reside in one state and work in another, students, and traveling either to or from Oregon. Updated/tweaked version of this material will be discussed at next meeting.
Provider reimbursement. Brainstormed various questions on what research would be needed from consultants before the discussion planned for the next meeting of this committee. Various reimbursement types will be discussed, including value-based, fee for service, capitation, and global budget systems; some other systems have some experience we can learn from.
