Oregon is shipping 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 disease. health effects of extreme heat, forest fire smoke and other climate-related disasters.
The equipment, which began fielding in March, expands the Biden administration’s 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 spend billions of Medicaid dollars on programs such as helping the homeless find housing and preparing healthy meals for people with diabetes, according to KFF. Oregon is the first to explicitly use Medicaid money for climate-related costs, part of its five-year, $1.1 billion effort to address social needs, which also includes housing benefits and nutrition.
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 issue,” so we need to 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 during a visit to Sacramento, California, in early April.
Becerra said the Biden administration wants states to experiment with how best to improve patients’ health, whether by keeping someone housed rather than homeless, or reducing their exposure to the heat with an air conditioner.
But Medicaid’s expansion of social services could 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 Medicaid and Health Safety Net Reform Initiative at the Paragon Health Institute.
“There are 600,000 to 700,000 people with intellectual disabilities in the United States waiting for Medicaid services. They are on a waiting list,” said Alexander, who oversaw the state health agencies of Pennsylvania and Rhode Island. “Meanwhile, Medicaid has money for housing, food and air conditioners for beneficiaries. It seems to me that we should serve the intellectually disabled first before tackling all these new areas.”
Scientists and public health officials say climate change poses a growing health risk. More frequent and intense floods, droughts, wildfires, extreme temperatures and storms cause more deaths, cardiovascular disease from poor air quality and other problems, according to the fifth national assessment of the federal government’s climate.
The growing health effects disproportionately hit low-income Americans and people of color, who are often covered by Medicaid, the state-federal health insurance program for low-income people.
Most of the 102 Oregonians who died during the deadly heat dome who moved to the Pacific Northwest in 2021 “were elderly, isolated and living with low income,” according to a report from the Oregon Health Authority, which administers the state’s Medicaid program, with about 1.4 million registered. OHA’s analysis of urgent care and emergency room utilization from May to September 2021 and 2022 found that 60% of patients visits for heat-related illnesses came from residents of areas with median household incomes below $50,000.
“Over the past ten years, the number of fires and smoke and excessive heat events that we experienced showed the disproportionate impact of these events on low-income people,” said Dave Baden, OHA deputy director of programs and policy.
And because dangerously high temperatures are not common in Oregon, many residents don’t have air conditioning in their homes.
Traditionally, states affected by natural disasters and public health emergencies seek permission from the federal government to spend Medicaid dollars on emergency power, air filters and other equipment to help victims recover. But these requests came after the fact, following federal emergency declarations.
Oregon wants to be proactive and fund equipment that will help about 200,000 residents manage their health at home before extreme weather or climate-related disasters strike, Baden said. In addition to air conditioning units, the program will fund the purchase of mini-fridges to keep medications cold, portable power supplies to operate ventilators and other medical devices during outages, heaters for winter and air filters to improve air quality during wildfire season.
In March, the 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, a person with an underlying health condition that could worsen during a heat wave and who is also at risk of homelessness or who has been released from prison in the past year could receive an air conditioner. But someone with stable housing might not qualify.
“You could be in an apartment complex and your neighbor would get an air conditioner and you wouldn’t have it,” Baden said.
At the offices of insurer AllCare Health in Grants Pass, Ore., air conditioners, air filters and mini-fridges were crammed into three rooms in mid-April, ready to be handed out to Medicaid patients. The health plan provided equipment to 19 households in March. The idea is to get supplies into homes before the summer fire season. engulfs the valley in smoke.
Health plans don’t want to find themselves “fighting the masses” at Home Depot when the skies are already smoky or the heat is unbearable, said Josh Balloch, AllCare’s vice president of health policy.
“We’re competing against everyone and you can’t find fans 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 in the climate change category. For example, California offers air purifiers to help asthma patients and New York just received federal approval to provide air conditioners to asthma patients.
Baden said Oregon health officials will evaluate whether sending air conditioners and other equipment to patients saves money by reviewing their claims files in coming years.
If Oregon can help enrollees avoid a costly trip to the doctor or emergency room after extreme weather, other state Medicaid programs may ask the federal government if they can adopt this benefit. Many states have yet to use Medicaid money to combat climate change because it affects people and regions differently, said Paul Shattuck, a senior researcher at Mathematica, a research organization that surveyed directors state Medicaid authorities on the issue.
“Health risks from climate change are pervasive, but the nature of risk exposure is completely different in each state,” Shattuck said. “It’s been difficult for Medicaid to gain scale because each state is left on its own to figure out what to do.”
Last year, a California state lawmaker introduced legislation that would have required Medi-Cal, the state’s Medicaid program, to add a climate benefit to its current expansion of social services. The program would have been similar to Oregon’s, but AB 586, led by Assembly Member Lisa Calderon, died in the Assembly Appropriations Committee, which questioned in a staff analysis whether “climate change remediation supports could 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 could worsen in extreme heat, a said Catherine Potter, a community health consultant with the health system. The following year, Kaiser Permanente estimated it avoided $42,000 in heat-related emergency room visits and $400,000 in hospital admissions, she said.
“We didn’t have extreme heat like this before, and we do now,” said Potter, who has lived in temperate Portland for 30 years. “If we can prevent these negative impacts, we should prevent 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 main operational programs of KFF — the independent source for health policy research, polling and journalism. KFF Health News is the publisher of California Health Linean editorial service independent of California Health Care Foundation.
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