Oregon to cover health-related climate costs

PORTLAND, Ore. — Oregon is about to become the first state in the nation to cover the costs of climate change for certain low-income patients under its Medicaid program as the normally temperate Pacific Northwest sees longer heat waves and more intense wildfires.

The new initiative, scheduled to take effect in 2024, would cover payments for devices such as air conditioners and air filters for Medicaid members with health problems who live in an area where an extreme weather emergency has been declared by the federal government or the Cabinet Office of governor, according to the Oregon Health Authority.

It aims to help people “dealing with the impacts of extreme heat, wildfires and other disasters caused by climate change,” said OHA Director Patrick Allen.

The measure is part of what the U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services describes as “groundbreaking Medicaid initiatives” in Oregon and Massachusetts.

On Wednesday, the federal agency renewed the Medicaid waiver for both states. These exemptions will cover non-medical services such as food and housing for people with clinical needs in an attempt to address the underlying social problems that can cause ill health.

Oregon will receive $1.1 billion in new federal funding for new Medicaid initiatives covering climate change, nutrition and housing, described as “health-related social needs” by health officials. The state will pilot the changes over the next five years.

“Health care does not happen in a vacuum — it’s clear that we must look beyond the traditional, siled approach to truly meet the needs of people, especially those experiencing complex challenges,” Oregon Gov. Kate Brown said in a statement.

Massachusetts Governor Charlie Baker said his state will “continue to implement innovative reforms that deliver quality care, better health outcomes and equity.”

Oregon’s new Medicaid plan features two first-in-the-nation policies: climate change coverage and a measure that would keep children continuously enrolled in Medicaid until age 6 without families having to re-enroll each year.

Officials in the Pacific Northwest are trying to adjust to the likely reality of more intense heat following the region’s fatal “heat dome” weather phenomenon, which caused record temperatures and deaths in the summer of 2021.

About 800 people died in Oregon, Washington and British Columbia during the heat wave as temperatures soared to an all-time high of 116 Fahrenheit (46.7 Celsius) in Portland and broke heat records in cities across the region . Many of the dead were older and lived alone.

In addition to covering payments for devices that maintain healthy temperatures and clean air in the home, Oregon’s new Medicaid plan will also cover generators in the event of a power outage.

“This is based on the medical indication that you are particularly vulnerable to heat events or have medical devices that are powered or sensitive to smoke,” Allen said.

Oregon Medicaid members with health problems will be eligible for such devices if they live in an area that has declared an extreme weather emergency.

Climate change may pose health risks, including heat-related illnesses during heat waves. Extreme weather events such as storms and floods can also negatively affect health, both physical and mental, and disrupt food systems. The risks disproportionately affect low-income communities, the elderly, and those with co-existing health conditions.

Medicaid is a federal-state health insurance program that helps pay for health care for low-income people of all ages. Each state determines eligibility and the full scope of covered services. The federal government reimburses a percentage of the state’s costs.

“There’s a lot of discussion around climate change about making sure that as we address the health risks of a changing climate, we do so in a way that reduces inequalities,” said Christy Eby, a professor at the Center for Health and the Global Environment at University of Washington.

Oregon’s Medicaid initiative “is an opportunity to reduce some of those inequities for people who can’t afford, for example, a generator to make sure that life-saving equipment keeps running during heat waves,” Eby said.

As for Medicaid coverage for food and housing assistance, Oregon and Massachusetts expand eligibility for such services.

Nutritional support can include personalized meal plans based on health needs and Medicaid-funded prescriptions for fruits and vegetables. Housing services can include help with rental applications, relocation assistance, and eviction prevention.

Massachusetts will provide additional nutrition support for Medicaid members who are children or pregnant women with special clinical needs, according to the Centers for Medicare and Medicaid Services.

In Oregon, people experiencing life transitions, including those experiencing or at risk of homelessness, may be eligible for rental assistance for up to six months.


Claire Rush is a corps member of the Associated Press/Report for America Statehouse News Initiative. America Report is a national nonprofit program that places journalists in local newsrooms to report on undercover issues. Follow her on Twitter @ClaireARush.

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