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Accessing Medicaid in Oregon has changed. As of early 2021, the Oregon Department of Human Services started using a new software system, called ONE. An objective of the change was to provide more control and participation by the applicant. While this program administers most financial public assistance programs, we will only reference Long-Term Care Medicaid.
In prior years, consumers had a specific worker or a small group of workers at the local branch to contact about applying, making changes, or asking questions. Oregon wanted applicants to have a centralized phone number, fax, and email to get help; additionally, the state moved to a banked caseload, sometimes across the state rather than a local branch.
The difficulty with this change is finding a consistent person to work on the case. As an applicant is asking questions, applying, and turning in documents, or trying to work through changes, the applicant will likely get a different worker every time, even if it is about the same issue. Depending on the complexity of the matter, the applicant could spend hours on the phone going through the same information with different workers.
How do users have more control and participation?
A goal of ONE was to allow consumers to log into their portal and add documents to their case. Unfortunately, as of December 2021, the document upload function is not working. It has never worked properly. This mostly presents a problem when the applicant is adding a form or item that is not specifically requested by a DHS employee. When a worker requests a document, the applicant can add the corresponding document but cannot add different or supporting items. The other way to send documents to DHS is by emailing to a centralized address. Currently, this approach is taking more than one month for a response.
Why is Oregon using a call center?
The state hoped to better allocate applicant calls so it created a Virtual Eligibility Center (VEC). Due to population, number of applicants, or staffing. some branches were busier than others. If a branch has multiple employees out of the office due to illness, vacation, or training, overflow calls can be routed to other branches to help.
Calling the VEC presents wait times that often exceed two hours. An applicant may be able to get their questions answered, but that depends on the experience of the worker who answers the phone. Wait times of multiple weeks are being experienced when an applicant wants to make a change, associate an Authorized Representative, or revise something. Applicants are often instructed to contact a local office or use fax or email described above.
What are the benefits of ONE?
ONE is designed to make case decisions with built-in rules instead of relying on worker knowledge and experience. Depending on the program an applicant is applying for, and the information provided, the application might be processed immediately however, not all the programs run correctly and they may result in incorrect denials. The success of the program often depends on the group applying (single person, parent and children, spouses, etc.) and what that group has in respect to finances and care needs.
Another benefit of ONE includes having a centralized place for all an applicant’s documents, getting emails or electronical notices instead of paper, applying after office hours, and viewing the benefit type and other general information to reference. An applicant no longer needs to submit a paper application (the option is available, but it is over seventy pages and is not intuitive).
ONE also integrated an Asset Verification Service obtaining general information from various banks which may save the applicant from having to access the records themselves (this is something an applicant or representative must agree to). It is especially beneficial when applying for someone who might not remember where he or she banks, or if there is any property held. However, following up on the information if the worker sees something unexpected might be difficult and could result in a denial. It also pulls from a specific date which may cause problems in the application.
Can I do this on my own?
Applying for Medicaid, and specifically long-term care, usually comes at a time of high stress for the applicant and his or her family members. With the introduction of ONE, it became more difficult to get information and work with DHS. The ONE program will send many notices that are difficult to read and understand: often sending the same or similar notices multiple times adding confusion. When an approval or denial comes, it may be difficult to understand why.
The short answer is, yes, you can do it on your own and knowing what to ask or getting an explanation might be difficult. If you are given a denial notice, you may not know why, and working with the software and business model are stressors you do not need. The advantage of using an attorney as an Authorized Representative is that we will collect the information from an applicant, present it to DHS in a way that helps move the matter along, and we can interpret the notices for you. In short, we can spend the time working through the system so you can focus on care.
This article is for informational purposes only and does not constitute legal advice, nor does it establish an attorney-client relationship. For a consultation with an attorney at NW Estate Law, LLC, please visit www.NWEstateLaw.com, call (503) 543-1121, or email Cody@NWEstateLaw.com to schedule a meeting with Meredith Williamson about your specific case.