Information Memorandum Transmittal

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Division of Medical Assistance Programs Information Memorandum Transmittal Sandy Wood, Manager Research, Education & Develop. Section Authorized Signature Number: DMAP-IM-08-016 Issue Date: 2/01/2008 Topic: Subject: Applies to: Medical Benefits Mass mailing of OHP Standard informational materials to OHP clients, DHS clients not receiving medical assistance and other groups All DHS Employees Area Agencies on Aging Children, Adults and Families County DD Program Managers County Mental Health Directors Health Services Seniors and People with Disabilities Other (please specify): DHS staff - SPD, CAF, AMH, DMAP Message: DMAP is sending the following informational material about the OHP Standard reservation list to the groups and in the methods listed below. Week of January 28 mailings: February Medical Care IDs will include the OHP Standard informational brochure (OHP 3205). We will also include a card that explains that the brochure is informational and intended only for people who are not on the Oregon Health Plan (OHP) and need health care coverage. The card emphasizes that people listed on the DMAP Medical Care ID will continue to receive OHP coverage. Please reassure medical assistance clients that the brochure is meant for their family, friends and neighbors who do not have health care coverage. A provider notice and flyer to over 18,000 health care providers. An informational letter from Jim Edge and flyer to over 1,200 public schools. Week of February 4: We will mail the OHP 3205 to over 100,000 DHS clients who do not receive medical assistance, and to approximately 12,000 households on the Family Health Insurance Assistance Program (FHIAP) waiting list. We will include a card explaining why they are receiving the brochures.

If you have any questions about this information, contact: Contact(s): DMAP Communications Phone: E-mail: reservation.list.questions@state.or.us Fax:

DHS: division of medical assistance programs The information in this brochure applies only to OHP Standard. OHP Plus and other benefit packages have different eligibility requirements. You already may qualify for coverage through one of these packages. To see if you or anyone in your household is eligible, you must complete an OHP Application. To request an OHP Application, call 1-800-359-9517 or pick one up at your local DHS branch office. Upon request this publication can be furnished in an alternate format for individuals with disabilities by contacting: DMAP Office at 503-945-5772. Available formats are: large print, Braille, audio tape recording, electronic format and oral presentation. Oregon Department of Human Services 500 Summer Street NE Salem, OR 97301-1097 Telephone: 503-945-5772 www.oregon.gov/dhs OHP 3205 (Rev. 11/2007) Tired of not having health coverage? ARE YOU: Without health care insurance? Not pregnant? 19 years old or older? An Oregon resident? With an income below 100% of the federal poverty level? How it works If you answered yes to all of these questions, you may qualify for free or low-cost health insurance coverage through the Oregon Health Plan (OHP). The Oregon Department of Human Services has received federal approval to enroll approximately 10,000 new adults in OHP Standard, a health insurance program for low-income Oregonians. Because there are not enough openings to meet everyone s needs, DHS is creating a list of people who would like to apply for OHP Standard. You must place your name on the reservation list during January 28 - February 29, 2008. DHS will randomly select names monthly from the list starting in March. If your name is selected, DHS will mail you an OHP Standard application form. If you apply and qualify, you will be enrolled in OHP Standard. DHS wants you to be independent, healthy and safe. The Oregon Health Plan can help make that possible. get started There are three ways to get on the reservation list: FILL OUT a request ONLINE. Visit the OHP Standard reservation list Web site at www.oregon.gov/ DHS/open and enter your information electronically. MAIL a request. Complete the OHP Standard reservation request form. Forms are available at DHS or Area Agency on Aging (AAA) offices, county health departments and most major hospitals and clinics. sign up BY PHONE. Call 800-699-9075 or 503-378-7800 (TTY) Monday through Friday, 7:00 a.m. to 7:00 p.m. PST. If you cannot call during the hours listed, you can have anyone call for you they just need your name, date of birth and mailing address. remember You MUST place your name on the reservation list during January 28 - February 29, 2008, if you want to apply for OHP Standard.

DHS: division of medical assistance programs Está cansado de no tener cobertura de salud? SI USTED: No tiene seguro de salud No está embarazada Tiene 19 años o más Es residente de Oregón Tiene un ingreso igual o menor al 100% del nivel federal de pobreza CÓMO FUNCIONA Si usted respondió sí a todas estas preguntas, puede tener derecho a recibir cobertura de seguro de salud gratuita o de bajo costo a través del Plan de Salud de Oregón (OHP). El Departamento de Servicios Humanos de Oregón ha recibido autorización federal para inscribir aproximadamente 10,000 nuevos adultos en el OHP Estándar, un programa de seguro de salud para habitantes de Oregón de bajos ingresos. Debido a que no hay suficientes vacantes para satisfacer las necesidades de todos los interesados, DHS está creando una lista de personas que desean solicitar el OHP Estándar. Usted debe poner su nombre en esta lista de reservaciones durante el 28 de enero - 29 de febrero de 2008. DHS seleccionará nombres de la lista al azar a partir del mes de marcha. Si se selecciona su nombre, DHS le enviará un formulario de solicitud para el OHP Estándar. Si usted la presenta y reúne los requisitos, quedará inscripto en el OHP Estándar. DHS quiere que usted disfrute de independencia, salud y seguridad. El Plan de Salud de Oregón puede ayudar a que esto sea posible. COMIENCE Hay tres formas de poner su nombre en la lista: LLENE UNA SOLICITUD EN LÍNEA. Visite el sitio Web de la lista de reservaciones del OHP Estándar Web en www.oregon.gov/dhs/open e ingrese sus datos en forma electrónica. ENVÍE UNA SOLICITUD POR CORREO. Llene el formulario de solicitud de reservación del OHP Estándar. Los formularios se encuentran en las oficinas de DHS o de la Agencia del Área para Ancianos (AAA), en el departamento de salud del condado y en los hospitales y clínicas más importantes. INSCRÍBASE POR TELÉFONO. Llame al 800-699-9075 ó 503-378- 7800 (TTY) de lunes a viernes de 7:00 a.m. a 7:00 p.m. PST. Si no puede llamar durante esas horas, puede pedirle a otra persona que llame en su nombre. Sólo tiene que dar su nombre, fecha de nacimiento y dirección postal. RECUERDE Usted DEBE anotarse en la lista de reservaciones durante el 28 de enero - 29 de febrero de 2008, si desea solicitar los beneficios del OHP Estándar. La información de este panfleto corresponde sólo al OHP Estándar. El OHP Plus y los demás paquetes de beneficios tienen distintos requisitos de elegibilidad. Usted ya puede ser elegible para estar cubierto por uno de ellos. Para saber si usted o cualquier otra persona de su familia es elegible, debe llenar una solicitud del OHP. Si desea recibir la solicitud del OHP, llame al 1-800-359-9517 o pida una en su oficina local de DHS. A petición de los interesados, esta publicación se puede realizar en otros formatos a las personas con discapacidades; sólo tiene que comunicarse con: DMAP Office 509-945-5772. Los formatos disponibles son: letras grandes, Braille, grabación en cinta de audio, disco de computadora y presentación oral. Oregon Department of Human Services 500 Summer Street NE Salem, OR 97306-1097 Telephone: 503-945-5772 www.oregon.gov/dhs

Explanation card that will be included with the brochure (OHP 3205) in February Medical Care IDs Front Information about the enclosed brochure The enclosed brochure (OHP 3205) is for anyone in your home who is not on the Oregon Health Plan (OHP) and needs health care coverage. The people listed on your DMAP Medical Care ID will continue to receive OHP coverage. Please share the brochure with your family, friends and neighbors who do not have health care coverage. If you have any questions about the brochure, call the DMAP Client Services Unit at 1-800-273-0557. DMAP/CU 07-148 Back Información sobre el folleto adjunto El folleto adjunto (OHP 3205) está dirigido a todas las personas del hogar que no estén inscriptas en el Plan de Salud de Oregón (OHP) y necesiten cobertura de atención de la salud. Las personas que fi guran en su Identifi cación de Atención Médica de DMAp seguirán recibiendo la cobertura del OHP. Por favor comparta el folleto con sus familiares, amigos y vecinos que no tengan cobertura de atención de la salud. Si tiene preguntas sobre el folleto, llame a la Unidad de Servicios para Clientes de DMAP al 1-800-273-0557. DMAP/CU 07-148

Provider IMPORTANT INFORMATION Notice OHP Standard Reservation List open January 28 through February 29, 2008 The Department of Human Services (DHS) is preparing to open Oregon Health Plan (OHP) Standard benefit package to a limited number of people through a new process called the OHP Standard Reservation List. OHP Standard provides health care coverage to low-income, non-pregnant adults 19 years and older. A new process the OHP Standard reservation list People interested in getting an application for OHP Standard benefits must place their names on the OHP Standard reservation list. The reservation list will be open from January 28, 2008 through February 29, 2008. After the list closes, DHS will randomly draw a pre-determined number of names from the reservation list and send OHP Standard applications to those individuals whose names are drawn. DHS will repeat the monthly random drawing and mailing of applications until a number of participants that funding will sustain is reached. You can help us spread the word Because the time period during which people can place their names on the reservation list is limited, it is critical that the public be informed in advance and understand how to get on the list. You can help us spread this important information by posting the enclosed flyer in your office and sharing the information with your staff and patients. We will include an informational OHP Standard brochure with the February OHP Medical Care IDs. An explanation card will also be included asking clients to share the brochure with friends and family who are not on OHP. If asked, please reinforce the message that the information does not pertain to anyone who is currently listed on the OHP Medical Care ID, as they are already receiving benefits through other OHP benefit packages. Additional information and materials, including the reservation list request form, are available on the OHP Standard Web page at: www.oregon.gov/dhs/open Other benefit packages are still open Only OHP Standard, due to its limited openings, will require the reservation list process. Other benefit packages, including those that cover pregnant women or people who are under 19 years of age, have different eligibility requirements. Individuals need to complete an OHP application if they think they may be eligible. OHP applications are available by calling 800-359-9517 or at any DHS branch office. Contact for questions or to request more fliers E-mail your questions about the reservation process or requests for additional fliers to: reservation.list.questions@state.or.us DMAP 08-012

January 31, 2008 Dear School Principal Oregon Theodore R. Kulongoski, Governor Subject: OHP Standard Awareness Campaign Letter to Public Schools Department of Human Services Division of Medical Assistance Programs 500 Summer Street NE, E44 A number of your school families without health insurance now have an opportunity to sign up for a reservation list for the Oregon Health Plan s (OHP) Standard benefit package. Assisting People to Become Independent, Healthy and Safe An Equal Opportunity Employer Salem, OR 97301-1079 Voice - (503) 945-5772 FAX - (503) 373-7689 TTY - (503) 378-6791 The Department of Human Services (DHS) is preparing to open OHP Standard to a limited number of adults through a new process called the OHP Standard Reservation List. OHP Standard provides health care coverage to low-income, non-pregnant adults 19 years of age and older. A new process the OHP Standard reservation list People interested in getting an application for OHP Standard benefits must place themselves on the OHP Standard reservation list. The reservation list will be open from January 28, 2008 through February 29, 2008. After the list closes, DHS will randomly draw a pre-determined number of names from the reservation list and mail OHP Standard applications to those individuals whose names are drawn. DHS will repeat the monthly random drawing and mailing of applications until a number of participants that funding will sustain is reached. Please help us spread the word Because the time period during which people can place their names on the reservation list is limited, it is critical that the public be informed and understand how to get their name on the list. You can help us spread this important information by posting the enclosed flyer in your school and: including the flyer in any mailings you send from now until February 29 to your school families. handing out the flyer in each classroom for students to take home. keeping a supply of the flyers in the visitor s area of your office. sharing this information with your staff and partners and asking them to give the flyers to school families, clubs, and associations. using any or all of the information in the flyers in your school newsletters or other materials. HRB 1014 (4/00) DMAP 08-019

January 31, 2008 Page 2 Additional information about the OHP Standard reservation process, the reservation list request form and other materials, are available at: www.oregon.gov/dhs/open. Contact for questions or to request more fliers E-mail questions or requests for fliers to: reservation.list.questions@state.or.us I am personally very encouraged that we will be able to provide health care coverage to more Oregonians and appreciate any action you can take to help us inform the public about this important opportunity. Sincerely, James Edge, Assistant Director Division of Medical Assistance Programs Oregon Department of Human Services

Looking for low-cost or free health coverage? How it works OHP Standard provides free or low-cost health insurance to Oregon residents who: Do not have health care insurance* Are 19 years old or older* Are not pregnant* Have limited income* Because there are not enough openings to meet everyone s needs, DHS is creating a list of people who would like to apply for OHP Standard. You must place your name on the reservation list during January 28 - February 29, 2008. DHS will randomly select names monthly from the list starting in March. If your name is selected, DHS will mail you an OHP Standard application form. If you apply and qualify, you will be enrolled in OHP Standard. DHS wants you to be independent, healthy and safe. The Oregon Health Plan can help make that possible. get started There are three ways to get on the reservation list: FILL OUT a request ONLINE. Visit the OHP Standard reservation list Web site at www.oregon.gov/dhs/open and enter your information electronically. MAIL a request. Complete the OHP Standard reservation request form. Forms are available at any DHS or AAA office, county health department and most hospitals and clinics. sign up BY PHONE. Call 800-699-9075 or 503-378-7800 (TTY) Monday through Friday, 7:00 a.m. to 7:00 p.m. If you cannot call during the hours listed, you can have anyone call for you they just need your name, date of birth and mailing address. it s easy, it s fair, get on the list! The reservation list is only open from January 28 - February 29, 2008. OHP 3206 (Rev. 01/2008) The information above applies only to OHP Standard. Other benefit packages, such as those that cover pregnant women or people who are under 19 years of age, have different eligibility requirements and are always open. To find out if you are eligible for one of these benefit packages, complete an OHP application. OHP applications are *available by calling 800-359-9517 or at any DHS branch office.

Explanation card that will be included with the brochure (OHP 3205) mailed to DHS clients not on medical assistance and people on the FHIAP reservation list. Front Information about the enclosed brochure The enclosed brochure (OHP 3205) is for anyone in your home who is not on the Oregon Health Plan (OHP) and needs health care coverage. We are sending it to you because you or someone in your family, are either: receiving benefi ts through the Department of Human Services, or are on the Family Health Insurance Assistance Program (FHIAP) reservation list. Feel free to also share the brochure with your family, friends and neighbors who do not have health care coverage. DMAP/CU 08-020 Back Información sobre el folleto adjunto El folleto adjunto (OHP 3205) es para cualquier persona de su hogar que no está en el Plan de Salud de Oregón (OHP) y necesita cobertura de atención de la salud. Se lo enviamos porque usted o alguien de su familia: está recibiendo benefi cios a través del Departamento de Servicios Humanos, o está en la lista de espera para el Programa de Asistencia para Seguro de Salud Familiar (FHIAP). También puede compartir este folleto con familiares, amigos y vecinos que no tengan cobertura de atención de la salud. DMAP/CU 08-020