Patients, providers ‘in the dark’ as PacificSource’s Medicaid exit nears

Angie Wright opened Facebook as she does most days. But unlike other times, she saw a post that read like a nightmare: a news story reporting the health care network that her husband is enrolled in, PacificSource Community Solutions, planned to stop offering Medicaid services in Lane County.

Robert Wright has a string of chronic and debilitating illnesses. PacificSource has been his coordinated care organization for three years.

As part of Oregon Health Plan, the state pays insurers, including PacificSource, to provide low-income people with access to physical, mental and dental care as coordinated care organizations.

However, the state’s reimbursement rate to PacificSource is not covering expenses, in part due to the increase in Oregon Health Plan members in Lane County, leaders of the Springfield-based insurer say.

Angie Wright has not heard from either the state health authority or PacificSource — no messages in her account on Oregon ONE, the state’s online portal for assistance programs, and no phone calls. Her husband is one of nearly 90,000 people in limbo, along with doctors and health care practitioners who also have not received clear information about the PacificSource exit. 

“Keeping us in the dark is just wrong,” Angie Wright said.

Since PacificSource’s Sept. 18 filing, the health authority’s communication team has reiterated to Lookout Eugene-Springfield that Oregon Health Plan members in Lane County would not face immediate disruptions. But when asked what happens when PacificSource’s contract with the state expires Jan. 1, officials referenced a state “process.” 

A week later, Sept. 26, spokespeople offered clarity: Oregon Health Authority is not continuing negotiations with PacificSource in Lane County, and by 2026, it intends to have a new provider in place. If not, the agency could require PacificSource to extend services for up to 90 days into the new year. Meanwhile, Trillium, the other local coordinated care organization serving patients in Lane County, said it has the capacity to absorb members and is working with the health authority on whether that will happen. 

When learning of this update from Lookout Eugene-Springfield, Angie Wright asked a question lingering for a community of health care members and providers, “What’s it going to be like?” 

Primary care clinics face new setback

Amanda Warner and Eden Sisk opened Perigon Medical Clinic in Eugene this June, aiming to help some of Lane County’s roughly 131,000 Medicaid patients access care.

Their clinic had no warning a transition was coming. When Warner and Sisk heard the news, they reacted much like Wright.

“That’s just scary for a lot of people,” said Warner, a registered nurse and family medicine practitioner. 

Warner and Sisk were inspired to launch their own clinic in response to the worsening shortage of health care access and providers in Lane County.

Years of consolidation — including Optum’s 2020 purchase of Oregon Medical Group, which left thousands of patients searching for primary care — compounded the problem. The strain spilled into emergency departments, where patients face lengthy wait times as leaders scramble for solutions.

Warner worked in urgent care, often seeing very sick patients who had no access to follow-up treatment. She and Sisk set out to build a business model that made care affordable, contracting with PacificSource to serve Oregon Health Plan members. They focused there first, because nearly 70% of local Medicaid members are connected to care through the insurer.

Now they are rethinking their approach, weighing options from adopting a sliding scale to contracting with Trillium, the other coordinated care organization in Lane County, to keep serving Oregon Health Plan members.

“We are here, and we are going to do the work,” said Sisk, the clinic’s operations manager.  “We won’t stand down from a challenge.”

Uncertainty remains 

Clinics and Oregon Health Plan members alike have raised concerns about who accepts Trillium. PeaceHealth accepts both Trillium and PacificSource, but earlier this year McKenzie Willamette Medical Center ended its contract with Trillium and now takes only PacificSource.

Asked whether it could absorb 90,000 more patients, Trillium spokesperson Courtney Johnston said in an email to Lookout Eugene-Springfield, “Trillium has the capacity to support this transition and are working closely with OHA to understand their expectations.”

Before PacificSource began serving Lane County, Trillium was the sole coordinated care organization. It now covers about 30,000 people.

The health authority has not said whether it will transition PacificSource members to Trillium or bring in another provider. So uncertainty persists, even to government-run Community Health Centers of Lane County, which accepts Medicaid patients.

During the board of commissioners meeting Sept. 23 elected leaders said it was important to keep advocating for county patients and to focus on the best possible outcome despite the uncertainty.

“It’s not time for hand-wringing,” Commissioner Pat Farr said. “It’s a time for a march to action.”

Waiting while sick 

Angie Wright hasn’t caught a break since her Springfield home burned down in 2022. She and her husband moved into a recreational vehicle in Veneta. Around that time, Robert Wright was diagnosed with chronic obstructive pulmonary disease — a progressive illness that makes it difficult to breathe.

“I can’t find a job that would hire me, because of all my disability right now,” Robert Wright said. “I can’t go a few minutes without oxygen, so I can’t work an eight-hour shift.”

Robert Wright also frequently develops pneumonia and has brittle bone disease, a condition that leaves him vulnerable to fractures.

“If I cough too hard, I’ll break a rib and puncture a lung,” he said.

He has a pending Social Security application, which could give him access to Medicare — the same coverage his wife uses for her own health. Together, the couple spends much of their days either scheduling or sitting with doctors.

A lapse in care could interrupt those appointments, cut off medications or leave Wright without essential home equipment such as his oxygen machine. While the authority has promised no disruption and said PacificSource members don’t need to take any action now, his wife worries whether that is the right approach — and if the agency can follow through for families like hers with so many medical needs.

“If you have one doctor, it’s a big deal, but it’s not that big of a deal. When you have multiple specialists, and he’s planning to have surgery this coming year, hopefully, then we have home health care for a month and a half — you know, that’s another thing,” Angie Wright said. “Our calendar is full with appointments between me and him.”

This story has been updated to correct the spelling of Courtney Johnston’s name.

Ben Botkin, Lookout Eugene-Springfield’s politics and policy correspondent, contributed to this report.