Oregon Medicaid advisers, alarmed by the turbulent rollout of a new rent assistance benefit, pressed state health officials this week for answers over delays they acknowledged have left thousands of low-income Oregonians waiting for help.
Members of a state Medicaid advisory subcommittee heard during a meeting this week that officials deeply underestimated eligibility for the program and couldn’t say during the meeting how much money has already been spent.
Officials also had left regional Medicaid providers to determine for themselves how to administer the program, and their approach — and wait times — have varied widely. Advisory members said this patchwork approach makes it harder for applicants to navigate the process, especially in areas served by multiple health plans.
The concerns add to earlier reporting by The Oregonian/OregonLive, which found that of the 3,000 people approved for the benefit by one provider, CareOregon, as of mid-June, less than a third had received rent assistance payments. Since that reporting, state officials have more closely examined where delays were occurring, focusing on the role of coordinated care organizations and have launched investigations into whether they were meeting service standards.
State officials this week said other providers across the state had experienced similar delays, though the greatest number of complaints came in the Portland area served by Care Oregon. And they detailed some of the issues that contributed to the delays.
The housing benefit is part of a five-year federal waiver that lets Oregon use Medicaid dollars to address basic needs — such as housing, healthy meals and climate-related costs — to improve people’s health.
No other state has tried to roll out rent aid as a Medicaid benefit at this scale. Launched late last year, the housing benefit can cover up to six months of rent and utilities for Medicaid beneficiaries with serious health conditions or life changes that put their housing at risk.
Demand for the Medicaid housing benefit has been huge. In the program’s first six months, more than 10,600 Oregon Health Plan members statewide applied for rent or utility help, according to the state health authority. Another 7,000 in the Portland area were screened through the 211 social services helpline but not yet referred to Medicaid health plans.
As of April — the most recent statewide numbers available — about 2,700 statewide had received rent support. But thousands more have not, even as some face eviction proceedings in court.
The volume quickly exposed capacity limits.
“The need is substantial,” Jessi Wilson, the agency’s director of strategic operations for the Medicaid waiver, said during Monday’s meeting. “We are certainly finding lessons in early implementation to improve services for members.”
Ellen Pinney, an Oregon Health Authority ombudsperson serving as an independent advocate for Medicaid members, pointed to a July report showing that complaints about the housing benefit began appearing soon after rollout.
Different delivery models, different wait times
Oregon’s coordinated care organizations — regional insurers that administer Medicaid benefits — were allowed to decide how to run the benefit.
Most used intermediaries to either evaluate applications or facilitate payments to landlords, or both. But that introduced delays as cases were handed off or while gathering documents to determine eligibility.
For example, some organizations like CareOregon handed off members approved for the benefit to local rent assistance providers, who were then responsible for paying the rent. As of May, the state found that roughly 1,600 applicants were still waiting for referrals to local rental assistance providers under this model.
A small number of CCOs handled the whole process themselves — and had the shortest wait times, generally under 28 days. But they account for less than 10% of cases statewide.
State health officials said Monday that high demand and limited staffing had compounded administrative delays. The Oregon Health Authority has started pushing out $6.3 million in emergency funds to speed things along.
The agency also began investigations of some CCOs, demanding they prove they are meeting service delivery standards.
The state is also considering narrowing the eligibility for rent assistance, standardizing the application process and requiring certain documents upfront to cut down on delays.
Medicaid waiver fuels new benefits
In 2022, Oregon made sweeping changes to its Medicaid program that reimagined what health care could look like for some of the state’s poorest and sickest residents by covering services from housing to healthy food.
The state secured $904 million in federal and state dollars to address social needs, such as housing, nutrition and climate-related costs — things not traditionally covered by Medicaid — through 2027.
The state began rolling out climate benefits, like Medicaid-funded air conditioners and air purifiers last spring. It then rolled out the housing benefits in the fall and nutrition benefits, like medically tailored meals, this year.
But it’s unclear how much the state has allotted to spend on the housing benefit and the other health-related social needs, like climate support, nutrition and outreach and engagement. The state did not respond to questions about how much it has budgeted to fund each type of service.
It’s also unclear how much the state has spent providing health-related social needs services and how much it has left in its budget for delivering housing benefits.
Kristen Lambert, a spokesperson for the Oregon Health Authority, said in an email that some of these benefits, particularly the rent assistance, have been available for less than one year and that the agency was still collecting data from health plans and housing providers “to be able to report the state spend in future years.”
Lambert said the agency has hired the Center for Outcomes Research & Education, part of the regional health chain Providence Health & Services, to independently evaluate the state’s federal Medicaid waiver and measure the programs’ health outcomes.
Oregon was one of the first states in the country to use Medicaid dollars for housing. Other states have launched similar services, as part of a national push to address health by tackling housing and other health-related needs like food insecurity.
But the novel use of Medicaid funds to improve health outcomes through non-medical spending may be in jeopardy. The Trump administration in March revoked some guidance supporting health-related social needs initiatives.
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