Oregon is implementing a groundbreaking initiative to utilize Medicaid funds in safeguarding its most susceptible citizens against the harmful health consequences of extreme heat, wildfire smoke, and other climate-related calamities. This innovative program involves the distribution of air conditioners, air purifiers, and power banks to those at risk, marking the first time a state has undertaken such an endeavor. Recently, Oregon has shipped these essential supplies to its vulnerable residents, including those who are most affected by the adverse impacts of climate change.
In March, the Biden administration implemented a strategy to extend the reach of Medicaid beyond conventional medical services and towards social services. As a part of this initiative, the equipment has been distributed to aid in this expansion.
According to KFF, numerous states, including California, Massachusetts, and Washington, redirect billions of Medicaid funds to aid programs that assist homeless individuals in securing housing and provide nutritious meals to those with diabetes. Oregon, however, is the first state to allocate Medicaid funding explicitly towards expenses related to climate change. This decision is a component of their comprehensive five-year, $1.1 billion initiative to address social necessities, which encompasses housing and nutritional benefits as well.
Health officials at both the state and federal levels are aiming to demonstrate the importance of investing in preventative measures before a crisis hits. The goal is to ultimately save both taxpayer funds and lives.
During a recent visit to Sacramento, California, Health and Human Services Secretary Xavier Becerra emphasized that preparing for extreme weather events is crucial for the health of Oregon’s most vulnerable residents. As he noted, “Climate change is a health care issue,” and therefore, it is important to take measures to protect the state’s poorest and sickest individuals from the potential dangers of heatwaves, droughts, and other weather-related hazards.
According to Becerra, the Biden administration is encouraging states to explore innovative ways to enhance patient wellbeing. For instance, this can involve providing housing to someone who would otherwise be homeless or mitigating their exposure to high temperatures through the use of an air conditioner.
According to Gary Alexander, the director of the Medicaid and Health Safety Net Reform Initiative at the Paragon Health Institute, there is a concern that the expansion of Medicaid into social services may result in duplication of existing programs for housing and nutrition that are already offered by other federal agencies. Furthermore, some individuals who are in dire need of medical care may not receive the necessary assistance they require.
As per Alexander, who has previously managed state health agencies in Pennsylvania and Rhode Island, there are approximately 600,000 to 700,000 intellectually disabled individuals in the United States who are currently waiting for Medicaid services. These individuals are on a waitlist while Medicaid has funds for providing housing, food, and even air conditioners to its recipients. In Alexander’s opinion, it would be more appropriate to prioritize serving the intellectually disabled population before venturing into these new areas.
According to the OHA’s assessment of urgent care and emergency room visits between May and September of both 2021 and 2022, individuals residing in areas with a median household income below $50,000 accounted for 60% of heat-related illness cases.
Dave Baden, the OHA’s deputy director for programs and policy, pointed out that over the past decade, there has been a significant increase in the number of fires, smoke events, and extreme heat events, which have had a greater impact on individuals with lower incomes.
Due to the rarity of dangerously high temperatures in Oregon, air conditioning is not a common feature in many residents’ homes.
In the past, when states were struck by natural disasters or public health crises, they would typically request permission from the federal government to use Medicaid funds towards vital equipment such as backup power and air filters to support recovery efforts. However, these requests were made after the fact, following federal emergency declarations.
According to Baden, Oregon is taking a proactive approach by financing equipment that will aid approximately 200,000 residents in managing their health at home before a climate-related catastrophe or severe weather event occurs. The program will cover the cost of air conditioning units, mini fridges to keep medications cool, portable power supplies to operate ventilators and other medical devices during outages, space heaters for the winter season, and air filters to enhance air quality during wildfire season.
The Oregon Health Plan, which is the state’s Medicaid program, initiated a program in March that requests health insurers to identify patients who may require assistance in dealing with severe weather. However, individuals must fulfill stringent federal criteria that classify them as “facing certain life transitions,” which is a rigorous set of guidelines that eliminate the vast majority of enrollees.
An individual who has an existing medical condition that could deteriorate during a heat wave and is also at risk of homelessness or has a history of incarceration within the past year can be eligible for an air conditioner. However, if an individual has a stable housing situation, they may not meet the criteria for receiving one.
Baden pointed out that it’s possible for you to live in a housing complex and find that your neighbor qualifies for an air conditioner while you don’t.
In mid-April, AllCare Health, an insurer located in Grants Pass, Oregon, had a collection of air conditioners, air filters, and mini fridges stacked up in three rooms. These supplies were meant to be distributed to Medicaid patients, and the health plan had already provided equipment to 19 households in March. The aim of this initiative is to ensure that people have the necessary supplies in their homes before the onset of the summer fire season, which often fills the valley with smoke.
According to Josh Balloch, AllCare’s vice president of health policy, health plans aim to avoid the chaos of large crowds during extreme weather conditions, such as smoky skies or unbearable heat, at places like Home Depot.
According to Baden, the efficacy of providing air conditioners and other equipment to patients in Oregon will be assessed by health officials by analyzing their claim records in the upcoming years.
According to Paul Shattuck, a senior fellow at Mathematica, a research organization that has conducted surveys on the issue, numerous state Medicaid programs have not yet utilized their funds for climate change as it impacts people and regions differently. However, if Oregon can help its enrollees avoid costly trips to the hospital due to extreme weather, other state Medicaid programs may follow suit and request the federal government to adopt this benefit.
In the previous year, a bill was proposed by a lawmaker in California that aimed to mandate Medi-Cal, the Medicaid program in the state, to incorporate a climate benefit within its current social services expansion. This proposed program was modeled after Oregon’s. However, Assembly member Lisa Calderon’s AB 586 was not passed by the Assembly Appropriations Committee. The committee raised concerns, as indicated in a staff analysis, regarding the definition of “climate change remediation supports” and their cost-effectiveness.
Kaiser Permanente has recognized the cost-effectiveness of its initiative. Catherine Potter, the community health consultant at the health system, revealed that in the aftermath of the 2021 heat wave, Kaiser Permanente dispatched air conditioners to 81 patients in Oregon and southwest Washington who were vulnerable to the adverse effects of extreme heat. As per Potter, the health system estimated that it had saved $42,000 in heat-related emergency room visits and $400,000 in hospital admissions in the subsequent year.
Potter, a long-time resident of the moderate Portland area, expresses concern over the current surge in extreme heat. She notes that such heat waves were not common in the past, and their occurrence is now more frequent. Potter emphasizes the importance of preventing the adverse effects of extreme heat, especially for those who are most vulnerable.
