OHA release - Ombuds Program, member concerns lead OHA to clarify policy, increase oversight.  SALEM, Ore. – Oregon Health Authority has reduced barriers that make obtaining medically necessary motorized wheelchairs and other durable medical equipment a challenge for the state’s approximately 1.4 million Medicaid members.  These challenges were brought to light by members who contacted OHA’s Ombuds Program, according to the program’s 2024 report. The report also recommends additional steps to further improve medical equipment access.  Durable medical equipment, or DME, includes a variety of tools that help people maximize their independence while living with health conditions. Wheelchairs, prosthetic limbs, blood sugar monitors and infusion pumps are examples of DME.  In recent years, the Ombuds Program has received inquiries from people enrolled in Oregon’s Medicaid program, the Oregon Health Plan, or OHP, who had difficulty obtaining coverage for DME – with many specifically needing motorized wheelchairs. In 2024, more than 80 individuals contacted the program with DME concerns.  Members inspire change:  The program’s case workers partnered with the Oregon Department of Human Services, Oregon Disability Commission and others to organize a group called the DME Think Tank. The group – which included 12 Medicaid members as well as caregivers, providers and representatives of advocacy groups – shared their personal experiences with OHA Medicaid policy and program staff.  During one listening session, a young woman with intellectual and developmental disabilities explained that her seven-year-old motorized wheelchair was beyond repair. Her local Medicaid network – also known as a coordinated care organization, or CCO – had denied her request for a replacement because it said staff at her group home could push her in a manual wheelchair instead. Unable to move on her own, the young woman could no longer interact with her neighbors or contribute to her household by collecting the mail every day.  One member of the DME Think Tank was a young man who became paralyzed after an accident. The report notes that he “felt dehumanized by the year-long struggle to get a mobility device that enabled him to do something as simple as navigate from his bed to the bathroom.”  After hearing these and other stories, OHA Medicaid staff committed to making changes. OHA took several actions as a result of the members’ feedback, including:  Oregon Medicaid policy was clarified to note having a caregiver is not a reason to deny coverage of motorized wheelchairs.  DME coverage was improved through regulatory rulemaking - OHA issued a verbal noting that the rules improvement process is continual and will be informed by Medicaid members’ experiences.  OHA increased its oversight by tracking prior authorization requests for DME as well as CCO denials of those requests.  Ongoing improvement - The Ombuds Program’s efforts to improve access to DME is ongoing. After several DME Think Tank members reached out in late 2024, the program worked with the Oregon Disabilities Commission and the Disability Services Advisory Councils to host three meetings during the first half of 2025 to discuss new or continued challenges and also recommended next steps.  Moving forward, the report recommends that OHA do more, including:  Formalize member involvement in an established DME advisory workgroup that hasn’t had regular member participation.  Collaborate with community members to review data from Medicaid member complaints and grievances; Evaluate Medicaid policies and rules to identify opportunities to advance health equity, including for policies and rules related to DME coverage.  Throughout 2024, the OHA Ombuds Program worked with 1,939 people who raised a total of 2,085 concerns about Medicaid. About 37% of those concerns were related to care access. Of all health service types, behavioral health was the focus of the largest share of concerns.  Since 2010, OHA Ombuds staff have helped Oregon Medicaid members obtain the care they need by helping OHA understand their voices and consider their perspectives while making decisions. To date, the program has received a total of 8,708 Medicaid concerns.  OHP members who encounter barriers to receiving care are encouraged to first work directly with their CCO to resolve any concerns. OHP members who are not able to receive the support they need from OHA or their CCO can contact the Ombuds Program by sending an email to [email protected] or calling 1-877-642-0450. The program’s phone message line is available in 14 languages. More information is on the OHA Ombuds program website.  Jointly funded by states and the federal government, Medicaid provides no-cost health coverage to adults, children, pregnant people, older adults, people with disabilities and others with lower incomes.