Oregon Health Plan (OHP)

Quick Facts

• Program administrator: Oregon Health Authority (OHA), in coordination with local Coordinated Care Organizations (CCOs).
• Coverage scope: Doctor visits, hospital care, prescription drugs, behavioral health services, substance use treatment, maternity care, dental, vision, and transportation to medical appointments.
• Enrollment model: Year-round applications through the ONE system, with 12 months of continuous coverage and streamlined renewals.
• Innovation: OHP integrates physical, behavioral, and oral health under regional CCOs, offering care coordination, community health workers, and culturally specific services.
• Expansion: Healthier Oregon initiative covers adults and children regardless of immigration status if they meet income and residency rules.
• Cost-sharing: No premiums or deductibles for most members; minimal copayments waived for essential services.

Program Overview

The Oregon Health Plan is the state’s Medicaid program, known nationally for its coordinated care model and emphasis on community-based health. In 2025 OHP continues to expand access through Healthier Oregon, extending full benefits to adults 19 and older regardless of immigration status if their income falls within limits. The program is central to Oregon’s strategy for reducing health disparities, integrating housing and social services into health care delivery, and addressing behavioral health crises.

OHP members enroll in Coordinated Care Organizations—regional networks of providers and community partners. Each CCO tailors services to local needs, offering care management, language access, and support for social determinants such as housing, food, and employment. With continuous coverage for 12 months, members maintain insurance even if income fluctuates, aligning with Oregon’s goal to minimize churn and administrative barriers.

Why OHP Matters in 2025

Oregon is implementing a Medicaid Section 1115 waiver that invests in social drivers of health. Starting in 2024 and ramping up through 2025, OHP covers medically necessary climate-related supports (like air conditioners during heat events), short-term rental assistance to prevent homelessness, and nutrition services for high-risk populations. By staying enrolled, members gain access to these innovative benefits alongside traditional care.

The state also launched OHP Bridge, providing continuous coverage for children up to age six and streamlined renewals for older kids. Pregnant members now receive coverage through 12 months postpartum, including behavioral health visits and lactation support. These enhancements help families avoid gaps in care during critical life stages.

Eligibility Deep Dive

1. Income thresholds: Adults age 19–64 qualify up to 138% of the federal poverty level (FPL). Pregnant people qualify up to 190% FPL, and children up to 300% FPL through OHP Plus. Older adults and individuals with disabilities qualify through OHP with Medicare Savings Programs and long-term care pathways.
2. Residency: You must live in Oregon and intend to remain. Provide proof like a lease, utility bill, or letter from a shelter. People experiencing homelessness can submit attestation with support from community organizations.
3. Citizenship/immigration: Citizens and qualified noncitizens qualify under standard rules. Healthier Oregon extends coverage to undocumented adults and youth who meet income and residency criteria. Provide identification (foreign passport, consular ID) and proof of Oregon address; Social Security numbers are not required under Healthier Oregon.
4. Other eligibility: Seniors and people with disabilities may need assessments for long-term services. OHP partners with Area Agencies on Aging for screenings.
5. Special populations: Youth aging out of foster care keep coverage to age 26, regardless of income. People leaving incarceration receive pre-release applications to ensure coverage upon re-entry.

Application Roadmap

1. Create ONE account: Visit one.oregon.gov or call OHP Customer Service at 1-800-699-9075. The online portal supports English, Spanish, and other languages. Use two-factor authentication for account security.
2. Gather documents: Proof of identity (driver’s license, passport, tribal ID), Social Security number (if available), proof of income (pay stubs, employer letter, unemployment statements), and proof of Oregon address. For Healthier Oregon, ID alternatives like a foreign passport or consular ID are acceptable.
3. Complete the application: Provide household members, income, pregnancy status, disability status, and health coverage details. Indicate if you need interpreter services or accommodations.
4. Submit verification: Upload documents online, mail copies, or deliver to local DHS/OHA offices. Community partners like Project Access NOW or regional health navigators can help scan and submit documents.
5. Choose a Coordinated Care Organization: After approval, select a CCO based on your county. Review provider directories to ensure your doctors participate. If you don’t choose, OHA assigns one but allows changes within 90 days.
6. Receive approval: Decisions usually arrive within 45 days, faster for pregnant individuals and urgent cases. Coverage can be retroactive up to 90 days if you incurred medical bills before applying.

Maximizing OHP Benefits

• Schedule a new member visit: Most CCOs offer incentives (gift cards, transit passes) for completing a wellness exam. Use the visit to review medications, preventive screenings, and care goals.
• Use care coordinators: If you have chronic conditions or complex needs, request a care coordinator to manage appointments, prescriptions, and social service referrals.
• Access behavioral health without referrals: OHP covers mental health therapy, substance use counseling, and peer support. Contact your CCO’s behavioral health line for providers.
• Tap dental benefits: Routine exams, fillings, crowns, and emergency dental care are covered. CCOs partner with dental care organizations; schedule checkups twice a year.
• Request non-emergency medical transportation (NEMT): CCOs provide rides to appointments. Schedule at least 48 hours in advance; urgent rides are available for same-day visits when medically necessary.
• Enroll in health-related services: Ask about housing supports, nutrition benefits, climate resilience equipment, and air filtration if you have qualifying health conditions.

Special Programs within OHP

• Healthier Oregon: Provides coverage regardless of immigration status. Community organizations like Causa Oregon and Latino Network offer enrollment assistance.
• OHP Bridge for Children: Guarantees coverage for kids under six without renewals. Parents must report major changes but kids remain enrolled until their sixth birthday.
• Pregnancy + Postpartum supports: Doula services, lactation consultants, home visiting programs, and postpartum mental health counseling are covered. Apply for the Family Connects program for nurse home visits.
• Behavioral Health Resource Networks (BHRNs): Regional hubs funded by Measure 110 offer harm reduction supplies, recovery housing, and treatment referrals without cost.
• Tribal health coordination: Nine federally recognized tribes operate health clinics that coordinate with OHP, ensuring culturally specific care. Tribal members can seek services without referrals.

Maintaining Coverage

• Respond to renewal notices: OHA sends renewal packets 60 days before coverage ends. Many members auto-renew using data from state agencies. If you receive a packet, complete it online or return by mail to avoid gaps.
• Report major changes: Notify OHP within 30 days if your household size changes, you move, or your income increases significantly. Healthier Oregon members retain coverage even if income fluctuates modestly.
• Keep contact info updated: Log into ONE to update addresses, phone numbers, and email. Missing mail can lead to closure.
• Appeal denials: If coverage is denied or terminated, request a hearing within 45 days. Legal aid organizations can help prepare appeals.

Troubleshooting and Support

• Application backlog: If processing exceeds 45 days, call OHP Customer Service or visit a local DHS office. Community partners can escalate urgent medical needs.
• Provider availability: If you struggle to find specialists, ask your CCO for out-of-network authorization. They must respond within 14 days.
• Prescription issues: OHP covers most medications, but some require prior authorization. Work with your provider to submit forms; pharmacies can provide emergency 72-hour supplies while waiting.
• Billing errors: If you receive a medical bill, call the provider and your CCO. Many bills are issued before OHP coverage is updated. Retroactive coverage can pay past bills within 90 days of application.
• Language access: Request interpreters for appointments. CCOs must provide language services at no cost. You can also request translated materials from OHA.

Resources and Contacts

• OHP Customer Service: 1-800-699-9075 (TTY 711), Monday–Friday 7 a.m.–6 p.m.
• Community Partners: Project Access NOW, Coalition of Communities of Color, Asian Health & Service Center offer enrollment assistance.
• CCO directories: Search by county on OHA’s website to compare provider networks and member resources.
• Member handbooks: Each CCO provides a handbook detailing benefits, grievance processes, and wellness programs. Download from the CCO website or request by mail.
• Legal Aid Services of Oregon: Offers help with denials, appeals, and debt collection issues linked to medical bills.

Timeline for New Members

Final Thoughts

The Oregon Health Plan delivers far more than medical coverage—it’s a gateway to integrated health, housing stability, and social support. By applying through the ONE system, partnering with your CCO, and tapping special initiatives like Healthier Oregon and social determinants benefits, you can secure comprehensive care for your family. Stay proactive: keep documents handy, schedule preventive visits, and communicate openly with care coordinators. Doing so transforms OHP from a safety net into a launchpad for long-term health and financial stability.