Oregon’s Medicaid patients have air conditioners and mini-fridges as climate change raises health concerns

Oregon is sending air conditioners, air purifiers and power banks to some of its most vulnerable residents, a first-in-the-nation experiment to use Medicaid money to prevent the potentially deadly. health effects of extreme heat, forest fire smoke and other climate-related disasters.

The team, which began rolling out in March, expands a Biden administration strategy to move Medicaid beyond traditional medical care and into the realm of social services.

At least 20 states, including California, Massachusetts and Washington, already direct billions of Medicaid dollars to programs such as helping the homeless get housing and preparing healthy meals for people with diabetes, according to KFF. Oregon is the first to use Medicaid money explicitly for climate-related costs, part of its five-year, $1.1 billion effort to address social needs, which also includes housing and nutrition benefits.

State and federal health officials hope to show that taxpayer dollars and lives can be saved when investments are made before a disaster strikes.

“Climate change is a health care issue,” so help Oregon’s poorest and sickest residents prepare for potentially dangerous heatdrought and other extreme weather conditions make sense, Health and Human Services Secretary Xavier Becerra said on a visit to Sacramento, Calif., in early April.

Becerra said the Biden administration wants states to experiment with how best to improve patient health, whether it’s keeping someone housed instead of homeless, or reducing their exposure to heat with an air conditioner.

But the expansion of Medicaid into social services may duplicate existing housing and nutrition programs offered by other federal agencies, while some Americans in need cannot get essential medical caresaid Gary Alexander, director of the Paragon Health Institute’s Medicaid and Safety Net Reform Initiative.

“There are 600,000 to 700,000 people with intellectual disabilities in the United States waiting for Medicaid services. They’re on the waiting list,” said Alexander, who oversaw state health agencies in Pennsylvania and Rhode Island. “Meanwhile, Medicaid has money for housing and food and air conditioners for recipients. It seems to me that we should address the intellectual disabilities before we go into all these new areas.”

Scientists and public health officials say climate change poses a growing health risk. Floods, droughts, wildfires, extreme temperatures and more frequent and intense storms cause more deaths, cardiovascular disease from poor air quality and other problems, according to the federal government’s Fifth National Climate Assessment.

The growing health effects disproportionately affect low-income Americans and people of color, who are often covered by Medicaid, the federal state health insurance program for low-income people.

Most of the 102 Oregonians who died during the deadly heat dome who settled in the Pacific Northwest in 2021 “were elderly, isolated and living on low incomes,” according to a report by the Oregon Health Authority, which administers the state’s Medicaid program, with about 1.4 million of registered OHA’s analysis of urgent care and emergency room use between May and September 2021-2022 found that 60% of visits for heat-related illnesses they were from residents of areas with a median household income of less than $50,000.

“In the last 10+ years, the amount of fire and smoke events and excessive heat events that we’ve had has shown the disproportionate impact of these events on those with lower incomes,” said Dave Baden, OHA assistant director of programs and policy.

And, because dangerously high temperatures are not common in Oregon, many residents do not have air conditioning in their homes.

Traditionally, states affected by natural disasters and public health emergencies have asked the federal government for permission to spend Medicaid money on backup power, air filters and other equipment to help victims recover. But those requests came after the fact, after federal emergency declarations.

Oregon wants to be proactive and pay for equipment that helps about 200,000 residents manage their health at home before extreme weather or a weather-related disaster, Baden said. In addition to air conditioning units, the program will pay for mini-fridges to keep medications cold, portable power supplies to run ventilators and other medical devices during outages, heaters for the winter and air filters to improve air quality during wildfire season.

In March, Oregon Health Plan, the state’s Medicaid program, began asking health insurers to find patients who might need help coping with extreme weather. Recipients must meet federal guidelines that classify them as “facing certain life transitions,” a strict set of requirements that disqualify most enrollees. For example, someone with an underlying medical condition that could worsen during a heat wave, and who is also at risk of homelessness or has been released from prison in the past year, could receive an air conditioner. But someone with stable housing may not qualify.

“You could be in an apartment complex and your neighbor qualified for an air conditioner and you didn’t,” Baden said.

At insurer AllCare Health’s offices in Grants Pass, Ore., air conditioners, air filters and mini-fridges were stacked in three rooms in mid-April, ready to be delivered to Medicaid patients. The health plan provided equipment to 19 households in March. The idea is to get the supplies to people’s homes before the summer fire season engulf the valley of smoke.

Health plans don’t want to find themselves “fighting the masses” at Home Depot when the sky is already smoky or the heat is unbearable, said Josh Balloch, vice president of health policy at AllCare.

“We’re competing against everyone else, and you can’t find a fan on a hot day,” he said.

Oregon and some other states have already used Medicaid money to buy air conditioners, air purifiers and other goods for enrollees, but not under the climate change category. For example, California offers air purifiers to help asthma patients, and New York just won federal approval to provide air conditioning to asthma patients.

Baden said Oregon health officials will evaluate whether sending air conditioners and other equipment to patients saves money by looking at their claims records in the coming years.

If Oregon can help enrollees avoid a costly trip to the doctor or ER after extreme weather, other state Medicaid programs may ask the federal government if they can adopt the benefit. Many states have yet to use Medicaid money for climate change because it affects people and regions differently, said Paul Shattuck, a senior fellow at Mathematica, a research organization that has surveyed state Medicaid directors on the issue. .

“The health risks of climate change are everywhere, but the nature of risk exposure is completely different in each state,” Shattuck said. “It’s been a challenge for Medicaid to get momentum because each state is left to their own devices to figure out what to do.”

A California state lawmaker introduced legislation last year that would have required Medi-Cal, the state’s Medicaid program, to add a climate benefit to the expansion of its existing social services. The program would have been similar to Oregon’s, but Assemblywoman Lisa Calderon’s AB 586 died in the Assembly Appropriations Committee, which questioned in a staff analysis whether “the supports for climate change remediation can be defined as cost-effective.”

The cost savings are clear for Kaiser Permanente. After the 2021 heat wave, it sent air conditioners to 81 patients in Oregon and southwest Washington whose health conditions could worsen in extreme heat, said Catherine Potter, a consultant for community health of the health system. The following year, Kaiser Permanente estimated it had avoided $42,000 in heat-related emergency room visits and $400,000 in hospital admissions, he said.

“We didn’t have extreme heat like this, and now we do,” said Potter, who has lived in temperate Portland for 30 years. “If we can prevent these adverse impacts, we should be preventing them especially for the people who will be most affected.”

This article was produced by KFF Health Newsa national newsroom that produces in-depth journalism on health issues and is one of the core operating programs a KFF — the independent source of health policy research, polling and journalism. KFF Health News is the publisher of California Healthlinea service editorially independent of the California Health Care Foundation.