Oregon State Program Helps Pay for Health Insurance for Low Income Residents

Over 600,000 Oregonians are without any type of health insurance. For the uninsured a serious injury or illness can have catastrophic financial consequences. Several studies have estimated that over fifty percent of all personal bankruptcies are due to medical reasons. The state of Oregon is working to reduce the number of uninsured citizens by paying up to 95 percent of health insurance cost for individuals and families.

Established by the legislature in 1997 and initially funded by tobacco taxes, the Family Health Insurance Assistance Program now helps approximately 18000 low income people pay for health insurance.

Income eligibility is based on 185 percent of the federal poverty line. For an individual to qualify for assistance their income cannot exceed $1511 a month. A family of four would qualify with an income of $3084 or less a month.

FHIAP categorizes clients into two groups for funding purposes: Individual- those without access to health insurance at work and Group – those whose employers do provide health insurance but the employee cannot afford the premiums.

To be eligible for a FHIAP subsidy, applicants must have been without insurance for six months, be a U.S. citizen living in Oregon, having savings and investments of less than $10,000 and not be eligible for or receiving Medicare. When determining savings and investments FHIAP does not count IRA’s, vehicles or owner occupied homes. Exceptions to the six-month rule are made when the applicant is leaving the Oregon Health Plan or has been on their employer’s insurance plan for less than 90 days.

After being accepted by FHIAP, those covered under the individual plan choose a healthcare provider on the state’s approved list. Choices include: Kaiser Permanente, ODS, Pacific Source, BlueCross/BlueShield and several others. For those with preexisting conditions FHIAP can secure coverage through the Oregon Medical Insurance Pool. Insurance providers bill FHIAP which in turn bills the individual for their share of the premium. On a $500 month premium subsidized at 95 percent FHIAP would pay $475. Like any insurance policy FHIAP recipients are responsible for deductibles and co-pays.

Knowing that people face a bewildering array of choices in choosing a healthcare provider FHIAP set up a toll free number where applicants can receive advice from experts about the best insurance policy to suit there needs.

Under the group insurance plan, members sign up with their employer’s health plan and the premium is taken directly from their paychecks. FHIAP reimburses members within four days of receiving a copy of their pay stub.

Once covered, members are required to reapply every 12 months. During the 12 month coverage period FHIAP does not require notification of any increase in income or assets.

According to FHIAP policy and legislative liaison Kelley Harms, the program’s enrollment zoomed from 3400 people in 2000 to the current 18,000 in 2005. Harms attributed the increased number of people of covered to aggressive marketing and the infusion of federal money starting in 2002. Federal matching funds account for 72 percent of FHIAP’s budget; with the state of Oregon making up the remaining 28 percent.

Currently there is no waiting list for those who can obtain insurance through their employer or their spouse’s employer. FHIAP is advising individual applicant that the waiting list for coverage could be up to 12 months.

Harms urges people in need of insurance coverage not to be put off by the possibility of a twelve month wait and to apply now. “Things change, people leave the program, and we could get more funding.” She said