Medicaid agency: Oregon Health Authority (OHA) / Health Systems Division / Oregon Health Plan (OHP)
Oregon Medicaid, branded the Oregon Health Plan (OHP), is administered by the Oregon Health Authority's Health Systems Division; aging, physical-disability, and intellectual/developmental-disability services sit with the Oregon Department of Human Services. OHP's Coordinated Care Organization (CCO) model, launched in 2012, assigns each region's CCO global risk for physical, behavioral, and oral health under a capitated budget; Oregon currently has 15 CCO service-area contracts across 12 corporate entities. OHP has operated under a Section 1115 demonstration since 1994, authorized through September 2027, and includes continuous eligibility for children under six and housing, nutrition, and climate-related social needs benefits; Oregon's HERC Prioritized List, a benefit-prioritization mechanism unique among states, funds services through line 470. Oregon expanded Medicaid in January 2014, and separately runs OHP Bridge (a Basic Health Program for adults between 133 and 200 percent of the federal poverty level) and Healthier Oregon (full OHP-equivalent coverage regardless of immigration status, funded by the state). Work requirements phase in starting 2027, requiring 80 hours per month of qualifying activity or $580 in monthly income.
CMS's most recent managed care enrollment data, report year 2024, shows 16 Comprehensive MCO plus MLTSS-classified CCO contracts, one row per service area rather than per corporate entity, since PacificSource Community Solutions and Trillium Community Health Plan each report multiple regional rows, for combined CCO enrollment of 1,309,000. Two PACE plans, AllCare PACE and Providence Elder Place, appear separately in the same report year, together covering 3,713 members.
Long-term services and supports are carved out of the CCO contracts entirely; nursing-facility-level-of-care and home- and community-based services run through the Oregon Department of Human Services' Aging and People with Disabilities division. Seven active Section 1915(c) waivers cover this population: the Aged and Physically Disabled Waiver, Adults HCBS Waiver, Children's HCBS Waiver, Medically Involved Children's Waiver, Medically Fragile (Hospital) Model Waiver, Behavioral (ICF/IDD) Model Waiver, and Children's Extraordinary Needs Waiver, plus a Section 1915(b)(4) Case Management and Freedom-of-Choice waiver covering aging, physical-disability, and tribal case management. OHA holds each waiver's federal Medicaid authority; ODHS runs day-to-day administration.
Not integrated into managed care
Behavioral health is capitated directly into each CCO's global budget alongside physical and oral health, built into the model by design rather than layered on afterward. There is no separate behavioral health PIHP or PAHP for the CCO population.
Carved in
Dental benefits run entirely through each CCO's own global budget. There is no distinct Dental Care Organization tier remaining.
Each CCO manages its own pharmacy formulary and preferred drug list. Oregon's Practitioner-Managed Prescription Drug Plan applies only to fee-for-service, open-card members, not to CCO enrollees. A single statewide preferred drug list remains under policy discussion following a state PBM transparency audit.
Non-emergency medical transportation is arranged locally rather than through one statewide broker; members find rides through their own CCO or, for fee-for-service members, a county-based broker. CareOregon is the delegated NEMT manager for three of Oregon's 15 CCOs (Columbia Pacific, Health Share of Oregon, and Jackson Care Connect); the rest arrange their own NEMT brokerage.
DXC Technology operates Oregon's Medicaid Management Information System (interChange). Deloitte Consulting operates the state's ONE eligibility system for Medicaid, SNAP, TANF, and child care assistance.
186 agency updates tracked for Oregon. Available with Pro.
See them with ProA nine-member Universal Health Plan Governance Board, created by the Oregon legislature in 2023, will deliver a proposal to lawmakers by December 1 for a single-payer system covering medical, vision, dental, and mental health benefits for all residents starting in 2032, with no premiums, deductibles, or copayments. Lawmakers could vote on the plan in the 2027 session or send it to voters as a 2028 ballot measure. The plan would replace insurance premiums and out-of-pocket costs with new corporate and personal taxes funding a single payment pool for all providers, and would make Oregon the first state with single-payer coverage if adopted. Similar ambitions exist in California, New York, and Washington, but prior single-payer efforts in Vermont and ballot measures in Colorado, Oregon, and California have all failed amid industry opposition.
Oregon Gov. Tina Kotek led governors from California, Maine, New York and Virginia in a letter urging HHS Secretary Robert F. Kennedy Jr. to delay the Jan. 1 effective date for new Medicaid work-requirement and eligibility rules stemming from the 2025 federal tax and spending law. The governors say final federal rules, issued six months after initial January guidance, contradicted that earlier guidance and changed the medical frailty definition, forcing states to rebuild eligibility systems, forms and verification processes with less than 100 days to spare. This is their second such request after a May 29 letter went unanswered by HHS. The governors cite CBO estimates that the new work-reporting requirements could leave 5 million people uninsured by 2034, with roughly half of coverage losses driven by paperwork and reporting errors rather than ineligibility.
Eleven rural hospitals and health systems in Eastern and Southwestern Oregon are seeking state approval to form a clinically integrated network called the Cascade High Value Network, allowing them to share resources while remaining independently operated. The effort, chaired by Lake Health District CEO Landon Dybdal, is being organized with help from for-profit consulting firm Cibolo Health, which has built similar networks in other states including North Dakota. The move follows an Oregon Hospital Association report finding the state has lost three community hospitals in recent years amid rising labor and supply costs, insurer payment disputes, and anticipated Medicaid cuts tied to federal reconciliation legislation (H.R. 1). Hospital leaders say the network model offers an alternative to the more common path of rural hospitals closing or being acquired by larger urban systems.
Democrat Chris Beck, challenging Republican Rep. Cliff Bentz in Oregon's 2nd Congressional District, is campaigning on protecting rural health care from Medicaid cuts included in the 2025 federal tax and spending law (H.R. 1). Beck argues the law, which Bentz supported, could cause rural hospitals to lose Medicaid reimbursements as patients lose coverage, calling it a potential "financial death knell" for rural facilities. He is calling for repeal of the law and voiced support for a national health system modeled on the Oregon Health Plan that would guarantee basic and preventive care. Bentz did not respond to an interview request; the race is ongoing ahead of the 2026 election.
Oregon's Department of Consumer and Business Services issued a consumer warning about self-funded limited partner plans that promise low premiums but typically cover only preventive care, leaving enrollees exposed to large medical bills. The warning comes as open enrollment for individual coverage begins November 1, with ACA-compliant premiums rising nearly 22% and subsidies shrinking. Regulators identified specific warning signs and companies marketing these non-ACA-compliant plans, which often misrepresent consumers as "limited partners" or "employees" to avoid consumer protection rules. The advisory matters for Medicaid stakeholders because cost-pressured consumers dropping or avoiding Marketplace coverage due to premium increases may cycle into Medicaid eligibility or present as uncompensated care for safety-net providers.
18 active waivers tracked for Oregon. Available with Pro.
See them with ProNo active solicitations currently tracked for Oregon.
18 managed care contracts tracked for Oregon. Available with Pro.
See them with Pro16 bills tracked for Oregon. Available with Pro.
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