By AMELIA TEMPLETON/Oregon Public Broadcasting

Oregon Gov. Tina Kotek has quietly chosen a group of health care executives, union representatives and care providers to advise her on how to tackle the looming budget crisis in the state’s Medicaid program.

The group met for the first time Nov. 5 and will meet every two weeks. Its recommendations are due to the governor no later than July.

The group’s work is inherently sensitive. Its charge, according to a charter document provided to OPB, is to recommend changes to “achieve sustainability” in the state’s Medicaid program as federal cuts kick in, while preserving access to critical services for the Medicaid population.

Health care policy experts told OPB some reduction in the benefits covered by Medicaid, known locally as the Oregon Health Plan, is likely given the state’s budget woes. The group could also potentially identify new taxes or other sources of revenue to prop up the program.

Medicaid cuts from the Republican tax and spending bill, HR 1 (previously named the One Big Beautiful Bill Act) phase in over time starting in 2027, at the end of the state’s current two-year budget cycle. Changes in the bill could cost Oregon roughly $11.7 billion in federal funding over the following decade, according to the Oregon Department of Administrative Services.

OPB learned of the Medicaid workgroup last week and asked to attend its first meeting. The governor’s office said the meetings are closed to the media and the public, citing an exemption in state open meetings law that allows some types of advisory groups to meet privately. Kotek declined to explain why it was necessary for the group to meet privately.

Medicaid is a taxpayer-supported program that provides health care to 1 in 3 Oregonians.

The advisory group has 18 members, according to a roster provided by the governor’s office. They come from all over the state and represent major financial stakeholders in the Medicaid program, including hospitals, doctors, dentists and labor unions.

Coordinated care organizations, which are local networks of doctors and insurers that contract with the state to run Medicaid, have the most seats in the group, with five CCO executives participating.

Also at the table is the Oregon Latino Health Coalition, the nonprofit that helped advocate for state-funded coverage for people in the country without legal status.

One notable omission: apart from the Latino Health Coalition, no consumer, disability or patient advocacy groups were chosen to participate. Disability Rights Oregon, the state’s leading advocacy group for people with disabilities, said they were not told about the closed-door group or invited to it.

Beth Brownhill, managing attorney at DRO, called the governor’s lack of transparency “appalling.”

“Any discussion about orchestrating Medicaid cuts that excludes people with disabilities and older adults is not only unjust, it’s dangerous,” Brownhill said. “Medicaid isn’t just insurance for our community. It’s the difference between living independently or in an institution, between accessing life-sustaining medications and going without.”

Lucas Bezerra, a spokesperson for the governor, said they will seek out additional perspectives as required to carry out the work.

The group’s official charter is broad, but according to Bezzara, the group is intended to be nimble and narrowly focused on services budgeted for within the Oregon Health Authority. The OHA oversees the Oregon Health Plan, which is essentially health insurance for people with little or no income.

A different agency, the Department of Human Services, manages some additional Medicaid-funded services and supports for people with disabilities and elderly adults.

“Nothing requires the Governor to pursue any recommendation produced. However, if any issues, learning or recommendations that may come from this group are pursued by the Governor, it will be weighed through a rigorous public process at that time,” Bezzara wrote in an email.

Other things that Oregon currently funds for Medicaid recipients without copays — including prescription drug coverage, dental benefits and hospice care — are not required by federal law.

Other stakeholders who weren’t invited to participate said the governor’s advisory group could be a promising start to tackling a thorny issue — but only if the group’s work is limited as the governor claims.

As the executive director of NAMI Oregon, Chris Bouneff has been a longtime advocate for people with serious mental illnesses and worked with the governor last session on a high-profile civil commitment reform bill. NAMI Oregon was also not offered a seat at the table, but that’s not necessarily a problem, Bouneff said.

He noted that members of the advisory group have deep technical expertise in the Medicaid program. But a narrow group of financial stakeholders should not be making decisions, or crafting fully-baked policy, he said.

Bouneff added that behavioral health services are often cut during lean times, which concerns him. But Kotek, he said, has built up some goodwill.

“She’s shown a real commitment to behavioral health,” Bouneff said.

Current and future cuts

While the Medicaid workgroup’s main focus is 2027 and beyond, its charter document also says the group may make recommendations for steps that need to begin in the current budget cycle.

Medicaid is one of the top line items in the state’s budget, and Oregon’s economy is showing signs of weakness. Facing an immediate shortfall, Kotek and the legislature need to cut more than $300 million from the budget this year. That’s in the near-term. The long-term financial picture for Medicaid is much worse.

The cost of providing health care in Oregon has been increasing faster than it was before the pandemic, climbing well past a 3.4% growth target set by the legislature for Medicaid.

And major cuts from the republican tax and spending bill will kick in starting in 2027.

In all, the bill could reduce federal spending on Medicaid in Oregon by nearly 20% over a 10-year period, according to an estimate by KFF, a nonprofit health policy research group.

That leaves policymakers with several unpalatable options: come up with a new tax, reduce the number of people enrolled in Medicaid, cut benefits or reduce payments to doctors and hospitals, for example.

In recent months, former Gov. John Kitzhaber, an emergency room doctor and one of the architects of Oregon’s Medicaid expansion, has been sounding the alarm about the fiscal crisis the program is facing.

Kitzhaber said it’s wise for Kotek to find advisors who can chart a clear strategy for how Oregon can deal with a sudden reduction in funds without simply cutting people from the Medicaid rolls.

“I do give kudos to Gov. Kotek for setting it up,” he said.

Kitzhaber said in the long term, Oregon needs to recommit to its efforts to bend the curve of cost growth and reduce the total cost of health care, to ensure that ballooning spending on programs like Medicaid doesn’t shortchange other priorities, like education.

But, he added, fixing the system will take time — a luxury the state doesn’t have. So in the short term, the group will have to figure out the most equitable way to make cuts.