Young adults with special health care needs may now qualify for no-cost health coverage and additional benefits through the state’s Medicaid program, the Oregon Health Plan (OHP). The new benefits are available to young adults ages 19-20 who meet income and health care needs requirements.
In Oregon, one in five children under age 18 has a special health care need – ranging from physical, intellectual and developmental disabilities to complex mental or medical conditions. However, when these young people turn 19, they lose their OHP health coverage. More than 80 percent of young adults with special health care needs don’t have adequate access to care or social services, even though they report needing more services than their peers.
The Young Adults with Special Health Care Needs (YSHCN) benefits extend OHP coverage, enhanced vision and dental services and the new health-related social needs climate and housing benefits to this population.
Oregon received permission from the federal government through a waiver to test whether increasing access to affordable care for young adults with complex health care needs will improve health outcomes and reduce inequities. The benefits are the first of their kind in the country. Oregon Health Authority (OHA) estimates that:
- 4,000 young adults will newly qualify for coverage through OHP
- 15,000 current OHP members will qualify for enhanced benefits
“As people with special health care needs age, they can face changes in insurance coverage that disrupt access to essential care,” said Steph Jarem, 1115 Waiver Policy Director at OHA. “Our goal is to increase access to affordable care and bridge the gap between pediatric and adult care. With these new benefits, young adults with complex health care needs will be able to access their regular care as they transition to adulthood.”
To qualify for the YSHCN benefits, young adults must:
- Meet the age requirement
- Have a qualifying health need
- Have an individual or family income up to 205% of the Federal Poverty Level (FPL)
Qualifying health needs include physical, intellectual and developmental disabilities; mental health conditions and long-standing medical conditions such as asthma, diabetes or spina bifida. Based on current FPLs, the income limit is $30,873 per year for an individual and $52,931 for a family of three.
Individuals interested in whether they qualify for the YSHCN benefits, can connect with their coordinated care organization (CCO) or apply online for the Oregon Health Plan. Young adults who are already OHP members and qualify for the new benefits should receive a letter asking if they want to apply. Applicants must apply for the benefits prior to turning 21 years old.
If an individual has additional questions, they can call the OHA Client Services Unit at 1-800-273-0557 or email Ask.OHP@odhsoha.oregon.gov.
For more information about these benefits, visit the YSHCN web page.
