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September 13, 2022
Media Contact: Liz Gharst, elizabeth.a.gharst@state.or.us, 971-666-2476
Needed improvements identified in four key areas
Oregon Health Authority’s (OHA) Ombuds Program, which serves as the advocate for Oregon Health Plan (OHP - Medicaid and Children’s Health Insurance Program) members, released a new report detailing top concerns from members of OHP during 2021. Established by legislation, the Ombuds Program provides recommendations and additional oversight internally to OHA Medicaid programs and externally to Medicaid contractors and is independent of Medicaid program implementation, operations or compliance.
The Ombuds Program advocates for access to care, quality of care and channeling member experience into recommendations for systems improvement. OHP members come to the Ombuds Program when they cannot get the support they need elsewhere and other avenues have not led to resolution. These issues often represent systemic concerns impacting other members. Margie Stanton, Director of OHA Health System’s Division, says “Elevating OHP member voice and perspective are essential for our agency to strengthen every part of our Oregon Health Plan for those we serve.”
The new Ombud’s Program 2021 report summarizes four areas of significant member concern:
- OHP member enrollment and member-centered transitions across services and benefits
- Care coordination improvements
- Language access and equity-centered approaches
- Mental health and substance use disorder (SUD) priorities and existing gaps
Adequate access to mental health and SUD providers, and all supporting behavioral health services, is a significant challenge for OHP members. This is an area that requires both Medicaid and behavioral health programs within OHA to coordinate and identify shared solutions for OHP members and for all Oregonians. Specific Ombuds concerns outlined in the report include:
- The need for timely and accessible mental health and SUD services at all levels of care;
- Inadequate mental health residential treatment and system capacity, for both children and adults;
- Underutilization of traditional health workers, particularly Peer Support Specialists and Peer Wellness Specialists; and
- Insufficient statewide capacity for inpatient and residential services, with member access further limited by CCO provider networks that may either be lacking availability by specialty, or that may not work with all inpatient facilities willing to accept OHP members.
The Ombuds Program continues to support efforts to address the challenges members experience in behavioral health and other areas. Critically, to turn member-centered Ombuds recommendations into actions that change operations and practice, OHA is treating the 2021 Ombuds report and all future annual Ombuds reports as formal audits which require a response and workplan. “The work of the Ombuds Program help bring issues to light that are critical to achieving our 2030 goal of eliminating health inequities,” says Stanton.
Read the full report here. To refer a concern to the Ombuds program, contact OHA.OmbudsOffice@dhsoha.state.or.us, leave a message at 877-642-0450 or visit here.
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