QuickTake:

Trillium, a Medicaid insurer, will absorb about 92,000 Lane County residents enrolled in the Oregon Health Plan who rely upon PacificSource for coverage. Oregon Health Authority officials have asked PacificSource to cover patients until Feb. 1 — one month after its contract expires Dec. 31.

Oregon Health Authority leaders are drafting plans for insurer Trillium to start covering about 92,000 Lane County residents enrolled in Medicaid who currently rely on PacificSource for health care coverage.

The handover became necessary after PacificSource, a Springfield-based insurer, notified the Oregon Health Authority that in 2026, it no longer would cover Lane County residents enrolled in the Oregon Health Plan, the state’s Medicaid program.

PacificSource cited financial losses as the reason for its pullout when it filed its intention Sept. 18 to not renew its contract in Lane County as a coordinated care organization. A flurry of activity ensued to quickly find a solution for residents who use PacificSource Community Solutions for Medicaid services.

The PacificSource Community Solutions is the larger of two entities that contract with the Oregon Health Authority to cover about 130,000 Lane County residents enrolled in Medicaid. The other entity is Trillium Community Health Plan.

The state pays these organizations to set up adequate networks of providers so people on Medicaid can access medical, dental and behavioral health services.

PacificSource covers about 92,000 Lane County residents, while Trillium handles about 30,000. This means Trillium’s patient load will quadruple to about 120,000 people early next year.

The increased caseload has concerned the health care community. Oregon Health Plan members and county commissioners have expressed concerns to the state about Trillium’s network of local providers, some of which have been dropped during its operation as a coordinated care organization in recent years.

Trillium’s network is expected to grow as part of the transition, said Dave Baden, the health authority’s deputy director for policy and programs.

“It really is Trillium’s hard work now to contract and build that network, and we’ll be helping,” Baden told Lookout Eugene-Springfield in an interview Thursday, Oct. 16.

PacificSource filed a transition plan, which the health authority is still finalizing, but appears likely to be approved, Baden said.

The plan addresses several facets of the transition, including prioritizing members with high-risk conditions and working with providers.  

That includes people undergoing dialysis or cancer treatment; pre- and post-transplant recipients; those receiving post-operative or post-discharge care; current or recent inpatients; and those on prescribed medications that cannot be interrupted.

According to the plan, the company will categorize members with high-risk conditions and place them into a system that supports an elevated level of coordination.

It’s a prioritization meant to ensure no disruptions happen and a successful exchange of health care records among administrators.

A one-month extension of PacificSource’s contract gives members and providers in the transition more time. This will allow for providers who are not yet in Trillium’s network to honor services that PacificSource had authorized for its members.

The Oregon Health Authority aims for a handover on Feb. 1.

“I’m pretty confident we’ll get there, but just note that that has not been signed, sealed and delivered,” Baden said.

Baden said patients enrolled in PacificSource should not switch over to Trillium right now and instead should wait to hear more details and information from the health authority and the coordinated care organization.

“If for whatever reason, their provider is not picked up by Trillium, there will be time and transition for continuity of care,” Baden said, adding that people should “continue to seek care as they’ve been seeking care now.” 

PacificSource is working with the Oregon Health Authority to draft and send notices to members, which will include websites and phone numbers where members can get help with questions or concerns.

For-profit health care company Centene Corp. owns Trillium Community Health Plan.

“Trillium is honored that the state of Oregon has recognized our commitment to providing high-quality care by selecting Trillium to serve additional Oregonians,” said Courtney Johnston, a spokesperson for Trillium. “We are collaborating closely with the Oregon Health Authority, who have affirmed our capacity and readiness to meet the needs of these additional members, to ensure a smooth transition of care.”

Ashli Blow brings 12 years of experience in journalism and science writing, focusing on the intersection of issues that impact everyone connected to the land — whether private or public, developed or forested.

Ben Botkin covers politics and policy in Lane County. He has worked as a journalist since 2003, most recently at the Oregon Capital Chronicle, where he covered justice, health and human services and documented regional efforts to fentanyl addiction. Botkin has worked in statehouses in Idaho, Nevada, Oklahoma and, of course, Oregon. When he's not working, you'll find him road tripping across the West, hiking or surfing along the Oregon Coast.