Changes to Medicaid Network Impacting Portland Residents
Recent reports indicate that a significant segment of low-income residents in Portland is losing access to important Providence health system specialty jobs due to alterations in the Medicaid insurance network that started this month.
CareOregon, which administers the affected plans, claims its broader provider network can handle these changes. However, some individuals remain skeptical and caution that longer wait times may be a consequence.
In a recent discussion, Jennifer Burroughs, CEO of Providence Oregon, implied that if CareOregon’s network encounters disruptions, then both the health system and insurers might reconsider their agreements.
“We have agreed with CareOregon that if we recognize a problem with the network’s adequacy, we will revisit the conversation,” she stated.
CareOregon manages what is arguably the largest Medicaid plan in the Portland area. While its members typically visit federally qualified health centers for primary care, they previously had the option to see specialists within Providence’s extensive network. This included neurologists, oncologists, and psychiatrists, along with expert providers from Legacy Health and Oregon Health & Science University.
Starting February 15, new referrals to most Providence specialists have been eliminated for over 200,000 members of the plan. This alteration underscores how financial strains and escalating costs are affecting healthcare accessibility for Portland’s residents.
Burroughs pointed out that certain exceptions still exist for members of the affected CareOregon plans. They can still access emergency services at Providence hospitals. Some old referral pathways remain functional—for instance, referrals to Providence gynecologists and pediatricians—while CareOregon Medicaid patients who are already seeing a Providence specialist may continue with those appointments.
However, when the more than 200,000 members of the CareOregon Oregon Health Plan search for referrals, they often have to look elsewhere for specialist care.
“We know some people are indeed being affected,” Burroughs said, adding, “We have strategies to ensure that those who are currently receiving care do not experience interruptions.”
Additionally, Burrows mentioned that Providence specialists are still accepting referrals from around 60,000 Medicaid members enrolled in Providence’s own insurance plan. (It’s worth noting that Kaiser Permanente and OHSU have smaller Medicaid plans in the area; Legacy Health’s version of the plan merged into CareOregon last year).
Burrows described the network adjustments as a “joint decision” made with CareOregon in pursuit of providing high-quality services more efficiently to Oregonians.
“When collaborating with CareOregon, they believed their specialty care network was ample enough to meet member needs without relying on Providence specialists,” Burrows explained. “We went back and forth, sharing data, and identified some areas where concerns arose regarding network adequacy, which we chose to keep open.”
