Many more could apply for OHP Standard and Healthy Kids programs
Analysis of the new federal health reform shows that by 2014, health care insurance will be available and affordable to more than 500,000 Oregonians—about 83 percent of those who now don’t have coverage.
But the health care package passed by the 2009 Legislature and signed into law by Gov. Ted Kulongoski means that Oregonians won’t have to wait that long.
Both Oregon Health Plan Standard and the state’s Healthy Kids initiative have grown since the new law went into effect, but there is still room to grow, and there are still eligible Oregonians who have not applied for coverage.
From state-developed resources comes this list of questions and answers about the plan that uninsured patients will find useful.
Oregon Health Plan Standard program (for adults)
(Information from the Oregon Department of Human Services)
Q: Who qualifies?
A: The Oregon Health Plan (OHP) Standard program provides free or low-cost health coverage to Oregon residents who:
- Do not have heath care insurance.
- Are age 19 through 64.
- Are not pregnant.
- Have limited income.
- Do not have Medicare.
Q: What if I’m not eligible?
A: The program described above applies only to the OHP Standard program. It does not apply to Healthy Kids, OHP Plus or any other health care program, which have different eligibility requirements.
People who want to apply for one of these other programs must complete an OHP application. To request an application, call 1-800-359-9517, TTY 711, or pick an application at a local branch office of DHS. Applications in English, Spanish, Russian and Vietnamese are also online.
Q: Are there openings in OHP Standard?
A: There are openings, but they are limited. The Oregon Department of Human Services (DHS) maintains a reservation list of people who want to apply for coverage under the OHP Standard program. Someone who wants to apply must first place their name on the reservation list. DHS will randomly draw names from the list. DHS will mail an OHP Standard application to those people whose names are drawn. Those who complete the application and qualify will be enrolled in OHP Standard.
Q: What does OHP Standard cover?
A: The Oregon Health Plan (OHP) Standard program covers:
- Physician services
- Prescription drugs
- Chemical dependency and mental health issues
- Emergency medical services
- Limited dental, hospital and vision benefits
Q: How do I get on the reservation list?
A: People who want to get on the list have three options:
- Fill out a request online at www.oregon.gov/DHS/open.
- Mail or fax a request. Pick up a form at all DHS/AAA offices, county health departments and most hospitals and clinics. The fax numbers are 503-373-7866 or 503-378-4139. The address is: OHP Branch P.O. Box 14520 Salem, OR 97309-5044.
- Sign up by calling 1-800-699-9075 or TTY 711. The hours are Monday through Friday, 7 a.m. to 6 p.m.
For your patients 19 and older:
A downloadable booklet about OHP is available here:
- English: Information about the Oregon Health Plan (OHP)
- Spanish: Información sobre el Plan de Salud de Oregón (OHP)
- Large print: Information about the Oregon Health Plan (OHP)
Oregon Healthy Kids (for children 18 and younger)
Q: What does Oregon Healthy Kids do?
A: Oregon Healthy Kids provides free or low-cost health care coverage to all children who are legal residents of Oregon. Even kids who have a pre-existing health conditions can enroll. The coverage lasts for at least one full year. It can continue as long as the child is still eligible.
Healthy Kids has three health coverage options—no-cost, low-cost and affordable—and is based on a family’s income.
Q: How do children qualify for Oregon Healthy Kids?
A: Children qualify for no-cost or low-cost coverage depending on their age, residency and income. The child must:
- Be under the age of 19.
- Live in Oregon and be a legal resident.
- Have had no health insurance for two months before they are eligible. (There are exceptions to this rule for special circumstances, such as a parent’s job loss or the child’s serious medical need.)
- Have a household income of no more than three times the Federal Poverty Level (FPL) to qualify for free or low-cost coverage. For a family of four, that’s about $66,000 a year. For smaller families, the income threshold is less; for larger families, the income level is more.
- Children in families earning twice the FPL ($44,100 for a family of four) or less will receive Healthy Kids coverage at no cost.
- An affordable option is available for households with annual income more than three times the FPL.
Q: How much does Healthy Kids cost?
A: Children in families earning between 200 and 300 percent of FPL but will get a subsidy for the cost of the monthly premium. The amount they pay will vary depending on the plan they choose and their location in the state:
Families earning between 201 and 250 percent of FPL will pay monthly premiums that range from:
- One child $18–$28
- Two to four children $31–$49
- Five or more children $45–$70
Families earning between 251 and 300 percent of FPL will pay:
- One child $27–$42
- Two to four children $47–$73
- Five or more children $67–$105
Q: How do I apply?
A: Families who want to apply for Healthy Kids coverage for their children may call 1-877-314-5678 to have an application sent to them. They can also complete an application online at https://apps.state.or.us/mbs. The form is available in English, Spanish, Russian and Vietnamese.
Q: Can I get help applying?
A: The Department of Human Services can give help filling out the application form. They can be reached at 1-877-314-5678 or at one of the DHS offices in the state. (See www.oregonhealthykids.gov/DHS/localoffices/locations.shtml#sdamap for an online directory of these offices.)
Online, there is a very long list of organizations that can help people with applications. You can find help in your county at www.oregonhealthykids.gov/DHS/healthykids/map-assisters.shtml.
For your uninsured patients under age 19:
You may download flyers about Healthy Kids in these languages:
You may also order brochures (in bundles of 25) and up to 10 posters from the state. Posters and brochures must be mailed to you. Please send an e-mail with your request to hkp.orders@state.or.us. Be sure to provide your name, address, what you want and how many you want.
