Medical necessity and defined coverage benefits in the Oregon Health Plan

Impact of Oregon's priority list on Medicaid beneficiaries

Since Oregon's controversial priority list was implemented in 1994, there has been only anecdotal evidence available on its possible impact on Medicaid beneficiaries. The authors surveyed over 1,400 beneficiaries to determine how often a service was denied because it was below the line, what kinds of services these represent, and any resulting health impact. About one third of all respondents reported that they had needed a service that Medicaid would not cover; in 38 percent of these cases, the reason was that the service was below the line. Frequently mentioned services included hernia repair, chiropractic treatment, dental splints, and newborn circumcision. About half of the respondents received the service anyway, often by paying for it themselves. Of those unsuccessful in getting the service, many reported that their health had worsened as a result. However, there was no evidence that getting (or not getting) the service had a causal impact on health status.