A Guide to the Oregon Medicaid Plan

When families have trouble making ends meet, an unexpected illness or injury can take a huge bite from a strained budget. Medicaid programs like OHP help families who wouldn’t otherwise be able to afford healthcare get what they need. In Oregon, about 35% (1,456,893) of the population receives free healthcare through OHP, which makes it possible for them to stay healthy and get the care they need for chronic and acute health concerns.

Eligible Oregonians can apply for one of three OHP (Oregon Health Plan) programs, which include coverage for basic health needs like physicals and screenings to treatment for complex medical emergencies. Unlike other states, which limit benefits for adults who do not have children or a disability, Oregon allows individuals of all ages to access the benefits if they meet the income requirements. For many people, Oregon Medicaid is a lifeline to the critical healthcare they need.

The following guide explains Oregon’s Medicaid program, answers your questions about OHP coverage, details how to apply for OHP, and what you can expect as a beneficiary of state healthcare insurance. You’ll learn how the program works, the eligibility requirements, what you get for coverage, and how to keep your benefits. Armed with this information, you can make informed choices about your family’s health insurance options and determine whether you need to purchase additional insurance to help cover the expenses that the state program doesn’t. To prevent shouldering the debt of unexpected medical expenses, many Oregonians extend their Medicaid coverage to include a more comprehensive range of benefits and services by way of private health insurance.

    What Is the Oregon Health Plan?

    OHO (Oregon Health Plan) is the name for Medicaid in Oregon. Like the 49 other states, Oregon cooperates with the federal government to give qualifying individuals access to healthcare at no or minimal cost.

    OHP works like any other insurance program. Members receive a Medicaid ID card they present to the healthcare provider or pharmacy when they seek care. The provider then bills the state directly at the agreed-upon rates and receives reimbursement from the state funds.

    Low-income Oregonians can apply for medical benefits via several programs, including:

    • OHP Plus, for children from birth to age 18 and adults aged 19 to 64
    • OHP Plus Supplemental, for pregnant adults aged 21 and up
    • OHP with Limited Drug, for adults who are eligible for both Medicaid and Medicare Part D

    The state also offers dental-only benefits and programs for designated groups, including veterans. For example, the Compact of Free Association (COFA) Premium Assistance Program includes full dental benefits for low-income residents of Oregon who emigrated from the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau.

    Coordinated care organizations (CCOs) manage OHP benefits. Your ZIP code determines your CCO as follows:

    • Columbia Pacific CCO - Columbia, Clatsop, and Tillamook counties
    • Yamhill County Care Organization - Yamhill and part of Washington counties
    • Pacific Source Community Solutions - Marion and Polk counties
    • Pacific Source Community Solutions - Lane County
    • Trillium Community Health Plan - Lane and Washington counties
    • Advanced Health - Coos and Curry counties
    • AllCare CCO - Curry, Josephine, and Jackson counties
    • Jackson Care Connect - Jackson County
    • Umpqua Health Alliance - Douglas County
    • Cascade Health Alliance - Klamath County
    • Pacific Source Community Solutions Central Oregon - Jefferson, Deschutes, and northern Klamath counties
    • Pacific Source Community Solutions Columbia Gorge - Hood River and Wasco counties
    • HealthShare of Oregon - Multnomah, Clackamas, and Washington counties
    • Eastern Oregon Coordinated Care Organization - Sherman, Gilliam, Morrow, Umatilla, Wallowa, Union, Wheeler, Grant, Baker, Lake, Harney, and Malheur counties

    All CCOs offer the same benefits and insurance coverage to members. The primary differences are the extra services and participating pharmacies. If you live in a county with multiple CCO options, you can select your preferred organization when you apply for OHP if it’s available in your ZIP code.

    If you earn too much for OHP, you may qualify for financial help from the state to purchase a health plan on the federal marketplace during the annual enrollment period.

    When you have an OHP plan, you do not have to pay out of pocket for healthcare services. The plan does not charge copayments or fees at the time of service or for any prescription medications. If you have Medicare and Medicaid, you may have to pay part of your premium for Medicare Part B, depending on your income and which program you qualify for.

    What Is an OHP Card?

    Oregon Medicaid

    When you receive health insurance through the Oregon Medicaid program, you will receive two cards: An OHP identification card and a card from your CCO (not shown above as they vary in appearance depending on the carrier). You must present both cards whenever you use your benefits (at the doctor’s office, a hospital, or a pharmacy).

    Medicare beneficiaries also receive an identification card when they enroll. You must bring all your cards to medical appointments if you have Medicare and Medicaid.

    How To Apply for OHP Coverage

    Although you can apply for the OHP in person or over the phone, the Oregon Health Authority recommends applying online and establishing a ONE Eligibility account. You can apply for benefits at any time and don’t have to wait for an open enrollment period.

    Before you apply for OHP, the state recommends completing the online pre-screening to pre-qualify for benefits. By answering a few simple questions about your income, household size, and medical needs, you can determine whether the OHP or another insurance coverage option is better for your situation.

    If OHP is appropriate for your needs, you can apply online immediately. Doing so requires submitting information, including:

    • Name, address, and contact information
    • Details about each person in your household applying for benefits, including the Social Security numbers or document numbers for legal immigrants and dates of birth
    • Details about income and employment for each person who earns money from W-2s, wage statements, or pay stubs
    • Information about any current health insurance policy you may have
    • Information about any employer health insurance options you can access
    • Details about your assets, like owned property, retirement plans, and life insurance policies
    • Details about veteran’s benefits, if applicable

    The Oregon Health Authority requires documentation of information you include on your application, which you can submit electronically. You may receive immediate approval confirmation if you provide all the required details. Otherwise, it could take several weeks to process your application.

    Even when you get instant online approval, you’ll receive a letter regarding your application. Approved applications will receive their enrollment information and ID card, and you can start using your benefits immediately.

    Eligibility Requirements

    Oregon’s requirements for Medicaid eligibility are less stringent than some other states, but you must demonstrate financial need to qualify. The general eligibility requirements are as follows:

    • Be a resident of Oregon
    • Meet the income guidelines for OHP based on your family size — the current guidelines are 138% of the federal poverty level for your family size
    • Be under age 65
    • Have documentation of your financial/household circumstances

    While most states don’t expand Medicaid benefits to childless adults, individuals in Oregon who meet the income guidelines may apply. The state also provides expanded eligibility for children. Children who qualify for Medicaid between ages 0 and 6 can keep their benefits until age six, regardless of family income, and families with incomes up to 300% of the federal poverty level can apply for the Children’s Health Insurance Program (CHIP).

    Seniors aged 65 and over who meet income requirements can also apply for OHP benefits, even if they have Medicare. Medicare and Medicaid are separate programs; most people enroll in Medicare at age 65 regardless of income. Qualifying seniors can use Medicaid benefits to cover some expenses that Medicare doesn’t, and in many cases, pay no or reduced premiums for their Medicare coverage.

    Getting an Oregon Medicaid Card

    Upon approval for OHP (Oregon Health Plan), the Oregon Health Authority will mail you an identification card and details about your new health insurance benefits. The local CCO will also send you an ID card and information about the specifics of the plan and local providers within 30 days. Your card will identify your primary care provider (PCP); if you want to change your PCP, call the CCO directly.

    Renewing or Replacing Your Oregon Medicaid Card

    OHP members can remain in the program as long as they are eligible. Program rules require enrollees to renew their benefits every year via a redetermination process on the anniversary of their enrollment date.

    During redetermination, the Oregon Health Authority will request documentation of your current circumstances to confirm your ongoing eligibility. You will have 90 days to submit the documentation. If you don’t provide the information, your Medicaid benefits expire in 60 days, and you’ll have to find alternate coverage.

    Medicaid recipients are responsible for notifying the Oregon Health Authority if their circumstances change before their redetermination date. Notify the office of address or job changes, significant income changes, and changes to your family size.

    You must also notify the Oregon Health Authority about a lost, stolen, or damaged ID card. Call immediately to request a replacement. If you lose your CCO card, contact the plan provider for a new one.

    Oregon Medicaid Coverage

    The list of what OHP covers is long. Although specifics vary by program or policy, Medicaid enrollees can access:

    • Primary care provider office visits
    • Preventive care, including well-child visits, vaccines, mammograms, and screenings
    • Physical, occupational, and speech therapy
    • Gender-affirming services
    • Inpatient/outpatient hospital care
    • Alternative medicine, including chiropractic and acupuncture
    • Family planning services
    • Maternity care
    • Vision care
    • Dental care
    • Behavioral Health services
    • Transportation to medical appointments


    OHP includes dental benefits for adults and children. Adults can get urgent care, general dental services (exams, cleanings, etc.), dentures, and stainless steel crowns on their back teeth. Children’s dental benefits add root canals, sealants, and limited orthodontia.

    The OHP Plus Supplemental Plan for pregnant women expands the dental benefits to ensure healthy teeth during pregnancy. The state also provides dental-only programs for specific individuals, including:

    • Citizenship Waived Medical (CWM), which covers dental emergencies
    • CWM Plus, which provides full dental coverage during pregnancy and for 60 days after birth
    • OHP Dental, for veterans and some COFA citizens

    While dental coverage is quite comprehensive for those enrolled in Oregon Medicaid, it doesn’t cover everything. For those who have more serious dental issues and anticipate requiring more visits to the dentists, investing in private dental plans in Oregan is advisable.

    Prescription Drugs

    OHP includes prescription drug coverage to ensure you can access medication. Individual CCO plans use a preferred drug formulary to determine which drugs you can get at no charge. If a provider prescribes a medication that is not on the list, they must seek pre-authorization from Medicaid. For general reference as to what drugs are covered under the plan, refer to this page, which is maintained by the Oregon Health Authority.

    According to the recommended schedule, Medicaid also covers vaccinations (shots) for adults and children. These vaccines include influenza and COVID-19 vaccinations as well as MMT, varicella, rotavirus, and HPV. Adults can access vaccines for pneumonia, shingles, hepatitis B, DTaP, and other recommended shots.

    Extended Health Care

    Oregon is one of 34 states to outline coverage for gender-affirming services, including hormone therapy, counseling, and some surgeries. Other extended services include smoking cessation assistance, like counseling, and benefits for nicotine replacement therapy and prescription medications.

    Travel and Out-of-State Coverage

    OHP (Oregon Health Plan) benefits do not transfer outside the state. You can only use your Medicaid elsewhere if you have a life-threatening emergency and cannot return home for care or if the services you need aren’t available from an Oregon provider. You can never use Oregon Medicaid for care outside the United States. If you are traveling outside of Oregon for leisure, invest in proper travelers insurance.

    Students and Seniors

    No one in Oregon needs to go without health insurance, including individuals between ages 19 and 64 who don’t have children. Thanks to the Affordable Care Act, college students can remain on their parents’ insurance policies until they turn 26, but if that’s not an option, they can apply for OHP.

    At age 65, seniors can enroll in Medicare. Most people contribute to the federal entitlement program through payroll taxes, and there is no income eligibility requirement. Although the monthly Medicare premiums are significantly lower than other insurance options, low-income seniors may need extra help, which they can access through a special needs program.

    Which program you can join depends on your income. The options include:

    • Qualified Medicare Beneficiary (QMB), which adds additional covered services to Medicare Part A
    • Specified Low-Income Medicare Beneficiaries and Qualified Individual-1 (QI-1), which pays the monthly Medicare Part B premium
    • Qualified Individual-2, which reduces the cost of Medicare Part B premiums

    Seniors who need assistance with long-term care, either at home or in a facility, can access help through several state programs.

    • Program for All-Inclusive Care for the Elderly (PACE) provides coordinated assistance to older people in their communities rather than in a facility.
    • Long-term care coverage varies by income and other factors.
    • Home health and hospice

    Coverage for Subgroups

    The state of Oregon offers Medicaid coverage for specific subgroups such as Native Americans, Alaskan Native and those who require treatment for breast and cervical cancer.

    Native Americans

    Native Americans and Alaska Natives enrolled in federally recognized Tribes, bands, or pueblos through private health plans on HealthCare.gov and public plans like the Oregon Health Plan can take advantage of special options pertaining to their healthcare.

    For Tribal members acquiring private health insurance via HealthCare.gov:

    • Plans with zero out-of-pocket costs: Eligible members with income at or below the family size limit ($77,250 for a family of four) can enroll in a cost-free plan, covering deductibles, co-pays, co-insurance, and prescriptions.
    • Plans with reduced out-of-pocket costs: Regardless of income, Tribal members can opt for a plan with no out-of-pocket expenses when seeking care from Indian Health Services, Tribal Clinics, or Urban Indian Clinics. They may also incur zero costs when referred by their Tribal clinic to another provider.

    Additional benefits:

    • Flexible enrollment: Tribal members can enroll in a private health plan at any time and change plans on a monthly basis.
    • No out-of-pocket costs for Indian health programs.
    • Consistent care: Members can maintain care with community providers at Tribal and Urban Clinics, potentially with financial savings to lower monthly premium costs for private health insurance.
    • Premium sponsorship: Tribes, tribal organizations, and urban Indian organizations may choose to cover premiums for qualified health plans for tribal members. For details on the Tribal Premium Sponsorship Program, contact us or your tribal organization.

    Oregon Breast and Cervical Health Care Program

    Individuals who require treatment for breast or cervical cancer but do not have adequate health coverage can apply for the Breast and Cervical Cancer Treatment Program (BCCTP). This program covers the cost of treatment for those under age 65 with incomes less than 250% of the federal poverty level. Individuals who are already covered by Medicaid automatically qualify for this benefit.

    What Oregon Medicaid Does Not Cover

    Services that Oregon Medicaid do not cover include the following:

    Private nursing
    Care provided by a family member
    Non-medically necessary elective surgeries
    Fertility treatments
    Experimental treatments
    Medical care outside the U.S.
    Medical equipment already replaced by a warranty
    Cosmetic orthodontia for adults
    Personal comfort items
    Non-emergency or non-medical transportation

    It’s also important to note that while Oregon Medicaid provides a small amount of funds toward the cost of a funeral, it most definitely doesn’t cover all expenses. Considering the rising cost of burial and related fees, ensure that your family is secured with comprehensive funeral insurance.

    Common Procedures and Oregon Medicaid Eligibility

    Oregon offers generous benefits to Medicaid recipients that go well above and beyond the federal requirements for state plans. You can review the plan materials to determine the specific coverage limits, but the following list provides a good overview of what OHP covers.

    Office Visits
    Primary care visits Yes
    Preventive care and screening services Yes
    Annual physicals Yes
    Routine lab work and X-rays Yes
    Behavioral Health
    In-home assistance Yes
    Mental health care Yes
    X-Rays and exams Yes
    Tooth extractions Yes
    Cleanings Yes
    Dentures Yes
    Orthodontia Yes, for children.
    Eye exams Yes
    Glasses Yes, for children. Adults are covered only for specific conditions.
    Screenings Yes, for medical conditions.
    Emergency surgery Yes
    Transplant services Yes
    Rehabilitation services Yes
    Inpatient hospital stays Yes
    Outpatient hospital services Yes
    Emergency care Yes
    Therapy and Counselling
    Oregon Medicaid covers speech therapy, physical therapy, occupational therapy, substance abuse and tobacco counseling.
    Maternity Care
    Gynecology Yes
    Family planning Yes
    Prenatal care Yes
    Doula services Yes
    Tubal ligation/vasectomies Yes
    Postpartum counseling Yes
    Newborn in-home visits Yes
    Specialist Services
    Chiropractic Yes
    Alternative and complementary medicine Yes
    Podiatry Yes
    Durable medical equipment and supplies Yes
    Diabetes testing equipment Yes
    Hospice service Yes
    Home care services Yes
    Ambulance services Yes
    Non-emergency medical appointment transportation Yes
    Telehealth services Yes

    Extending Oregon Medicaid Coverage

    OHP (Oregon Health Plan) is comprehensive, but there are gaps in its insurance coverage. For example, if you wear contact lenses or glasses, Medicaid doesn’t pay for them, and you will need to find an alternative source of coverage. When you need access to more providers, want to explore alternative treatments that Medicaid doesn’t cover, or don’t qualify for full OHP benefits, additional or extended health insurance may be necessary to ensure you have everything you need.

    The ever-increasing costs of medical care mean that many people put off necessary treatment and put their well-being at risk. For others, a single accident or unexpected injury can result in significant financial hardship. Coverage beyond Medicaid ensures this doesn’t happen while providing access to the care you need when you need it. Other types of private insurance, such as life insurance, can help pay for medical costs Medicaid will not cover, especially in the event of your passing.

    Consider these benefits of additional insurance coverage:

    • More Provider Choices. You must choose another doctor if your preferred healthcare provider does not accept OHP or participate in your local CCO. You might also need to travel long distances to access a specialist if there isn’t one in your local network. Enrolling in an extended coverage plan can mean you have a wider provider network and more choices for your healthcare.
    • Expanded Service. Although OHP covers alternative medicine options like acupuncture and chiropractic, there are limits on how many visits you get. A third-party policy fills the gaps if you want more options and the ability to go more often.
    • Additional Services. Medicaid doesn’t cover everything. When you need services, the plan doesn’t pay for a private policy that might give you extra coverage.
    • Wider Coverage Area. Give yourself peace of mind that you can access medical care without the potential for a huge bill when you have an insurance policy that works across state lines or outside the U.S.

    Evaluating your health insurance choices and finding the best one for your needs can feel overwhelming. With help from Insurdinary, it doesn’t have to be. Our simple quoting tool allows you to explore of all your options, including OHP (Oregon Health Plan), and find the ideal plan for your budget and medical needs.

    Visit Insurdinary to get your free, no-obligation health insurance quotes from local companies today, and relax, knowing you can get the healthcare you need.


    How long does it take to get approved for Oregon Medicaid?

    The approval timeline for Oregon Medicaid varies depending on individual circumstances. On average, the process takes around 45 days. Urgent cases can be expedited for quicker processing.

    What are the methods to apply for Oregon Medicaid?

    You can apply for Oregon Medicaid through various channels: online, in person, by mail, or at a local Department of Human Services office. Make sure to include necessary documents like proof of income, household size, and residency when submitting your application.

    Does Oregon Medicaid cover the expenses of funerals?

    No, Oregon Medicaid primarily provides healthcare coverage and does not include benefits for funeral expenses. If you're seeking assistance with funeral costs, you might want to explore options like funeral insurance.

    Who is eligible for Oregon Medicaid?

    Eligibility for Oregon Medicaid is determined by factors such as income, household composition, and other considerations. Typically, the program extends coverage to low-income individuals, families, pregnant women, children, elderly individuals, and those with disabilities.

    What is Oregon Medicaid?

    Oregon Medicaid is a program designed to offer medical coverage to eligible low-income residents of the state. Funded jointly by federal and state resources, its aim is to ensure access to essential healthcare services for those who qualify.

    What other types of insurance does Insurdinary offer?

    Insurdinary, and its network of partners offer many different types of insurance. In addition to health, dental, disability, life, funeral and travel insurance as discussed on this page, you may also be interested to explore the following:


    1. https://sharedsystems.dhsoha.state.or.us/DHSForms/Served/le8116.pdf
    2. https://www.healthcare.gov/
    3. https://sharedsystems.dhsoha.state.or.us/DHSForms/Served/de5530.pdf
    4. https://www.healthinsurance.org/medicaid/oregon/
    5. https://www.healthshareoregon.org/members/member-redetermination
    6. https://sharedsystems.dhsoha.state.or.us/DHSForms/Served/he7224.pdf
    7. https://www.oregon.gov/oha/ph/PreventionWellness/VaccinesImmunization/ImmunizationProviderResources/Documents/DMAPvactable.pdf
    8. https://www.sciencedirect.com/science/article/pii/S1743609520310626
    9. https://www.oregon.gov/oha/HSD/OHP/Tools/EPSDT-Member-Fact-Sheet.pdf
    10. https://www.oregon.gov/oha/HSD/OHP/Pages/BCCTP.aspx
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