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QuickTake:
With nearly 100,000 Lane County Medicaid members served by PacificSource being shifted to Trillium on Feb. 1, some 15,000 to 25,000 have doctors or clinics that not part of Trillium’s network. Trillium officials say they are “making positive progress” bringing more providers into its network but offered no specifics.
Essential background
The PacificSource-to-Trillium transition involves policy terms and timelines that can be confusing. Here are three basics to help:
- Medicaid coverage in Lane County is provided through the Oregon Health Plan, administered by the Oregon Health Authority, the state’s health agency. People in the plan are called members.
- The authority contracts with coordinated care organizations, or CCOs — typically insurance companies — which deliver members’ benefits through networks of health care providers.
- In Lane County, those CCOs are PacificSource Community Solutions and Trillium Community Health Plans, but PacificSource will no longer operate as a CCO after January 2026. PacificSource members will move to Trillium Feb. 1.
Oregon Health Authority and Trillium have not released specific numbers showing its progress in closing the gap for more than 15,000 people who were out of network last month in the ongoing Medicaid transition in Lane County.
Nearly 96,000 Lane County residents on Medicaid will be switched on Feb. 1 from PacificSource to Trillium as their coordinated care organization.
In December, Lookout Eugene-Springfield confirmed that between 15,000 and 25,000 members have doctors or clinics that are not in Trillium’s network. About 10% of PacificSource members — 9,600 people — have primary care providers who are not part of Trillium’s network. Nearly 16% of PacificSource members — 15,360 people — have behavioral health providers who are not in the network.
Last month, Brandie Thielman, Trillium’s vice president of network development, said the organization is working to close those gaps. Trillium has identified three primary care groups it could add, which would raise primary care coverage from 90% to 98%, and has identified 33 behavioral health providers to potentially add, which would increase behavioral health coverage from 84% to 97%.
Over the last week, since Jan. 7, Lookout Eugene-Springfield has repeatedly asked both the state health authority and Trillium about progress in closing the network gaps.
A statement from Trillium Monday, Jan. 12, didn’t provide numbers but said that the company was “making positive progress in our provider negotiations.”
The Trillium statement also said that the insurer is “in close coordination with OHA [Oregon Health Authority] when it comes to public reporting” and would “reach out directly when we have updates to share.”
“We do want to confirm all PeaceHealth clinics are in-network with us,” the Trillium statement said.
The health authority acknowledged receiving the inquires but did not answer questions from Lookout.
Over the last month, the health authority has sent a letter to Medicaid residents about the transition reiterating that Oregon Health Plan benefits will remain the same. However, the letter says, some members may need to change health care providers once the transition takes effect Feb. 1.