Paul Sanchez
In 2014, Oregon expanded its Medicaid program to cover all legally present residents with incomes up to 138% of the poverty line. This was facilitated by federal funding, with the Oregon Health Plan's budget increased by $1.17 billion to a total of $14.4 billion for 2013-2015. The Oregon Health Plan (OHP) is the state's Medicaid program, and it offers two plans: OHP Plus and OHP Bridge, with eligibility based primarily on income levels. Oregon has a history of progressive health coverage, adding mental health and chemical dependency coverage to Medicaid in 1995, and expanding basic coverage to all residents living in poverty before 2014.
| Characteristics | Values |
|---|---|
| Name of the health insurance | Oregon Health Plan (OHP) |
| Year of expansion of Medicaid in Oregon | 2014 |
| Eligibility | All legally present residents with incomes up to 138% of poverty |
| Other eligibility factors | Income levels, and other factors |
| Website | HealthCare.gov, Oregonhealthcare.gov, Oregon Health Plan website |
| Contact | OHP Customer Service at 800-699-9075 or TTY 711 |
| Mailing Address | OHP Customer Service, P.O. Box 14015, Salem, OR 97309-5032 |
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What You'll Learn
Oregon Health Plan's budget increase
In 2014, Oregon accepted federal funding to expand its Medicaid program, making coverage available to all legally present residents with incomes up to 138% of the poverty line. This expansion was facilitated by a $1.17 billion increase in the Oregon Health Plan's budget for 2013-2015, bringing the total budget to $14.4 billion.
In recent years, there have been further proposals to increase the Oregon Health Authority's budget. Lawmakers have proposed a $2.4 billion increase over two years, with a focus on expanding coverage. This includes a $922.9 million allocation to fund federally approved changes to the Medicaid-funded Oregon Health Plan, with $781.7 million coming from federal funds and the remainder from state funds. The Oregon Health Authority has also requested a $39 billion budget, which includes federal funds of over $20 billion, primarily for the Oregon Health Plan.
The $39 billion budget request by the Oregon Health Authority includes funding for various initiatives. One key area is residential treatment and behavioural health, with $176.1 million allocated for additional treatment beds across the state and $117.4 million to strengthen Oregon's behavioural health workforce. The budget also addresses the needs of incarcerated individuals, allocating $121.8 million for their medical care and transition support after release. Additionally, $39.6 million is designated for the new 988 crisis line and mobile crisis units, and $7 million is allocated for community mental health programs.
While the $39 billion budget request offers potential budget cuts, it also seeks to address health equity and homelessness. It aims to close Oregon's shortage in behavioural health treatment capacity and better serve individuals with severe mental illness. Furthermore, the budget includes funding for opioid harm reduction initiatives, totalling $40 million, which will be used to distribute Naloxone, an opioid overdose-reversing medication, to schools and other organizations.
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Medicaid expansion in Oregon
Medicaid in Oregon, known as the Oregon Health Plan (OHP), has undergone significant expansion over the years, with the state taking a progressive approach to ensure access to healthcare for its residents.
As early as 1994, Oregon expanded Medicaid to cover individuals with incomes up to the poverty level. This expansion was short-lived due to budget constraints, and enrollment was suspended between 2004 and 2008. However, Oregon's commitment to healthcare reform remained steadfast.
In 2014, Oregon took advantage of the Affordable Care Act (ACA) and accepted federal funding to further expand Medicaid. The state increased the Oregon Health Plan's budget by $1.17 billion for 2013-2015 to facilitate this expansion. This move ensured that all legally present residents with incomes up to 138% of the poverty level could enroll in Medicaid, and the federal government covered most of the costs for these newly eligible enrollees.
Oregon's expansion of Medicaid went beyond traditional federal income limits, making it the third state to do so, after Minnesota and New York. This expansion was notable as it offered coverage at no cost to the beneficiaries, without monthly premiums or co-pays. The OHP Bridge Plan, launched in 2024, extended Medicaid benefits to individuals and families with incomes up to 200% of the federal poverty level. This initiative aimed to provide free medical, dental, and mental health care to an additional 100,000 Oregonians by 2027.
The expansion of Medicaid in Oregon has been a collaborative effort between the state and federal governments, with the federal government committing to paying at least 90% of the cost of covering the expansion population. This partnership ensures that more Oregonians have access to essential healthcare services, demonstrating Oregon's dedication to improving the health and well-being of its residents.
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Oregon Health Plan's eligibility criteria
Oregon's Health Plan, also known as OHP, is the state's Medicaid program. The eligibility criteria for OHP are based primarily on income levels, but there may be other factors that determine eligibility. Coverage is available for all legally present residents with incomes up to 138% of the poverty line. The specific income levels that qualify for OHP are outlined on the CareOregon website, which is one of two coordinated care organizations (CCOs) serving the tri-county area.
OHP offers two plans: OHP Plus and OHP Bridge. While the differences between these plans are minor, eligibility is determined primarily by income level. The Oregon Health Plan website has renewal forms and full renewal applications available for existing members.
Prior to 2014, Oregon's Medicaid program was only available to pregnant women, children, seniors, and adults with disabilities. However, Oregon expanded its basic coverage to include everyone living in poverty, regardless of their special eligibility status. Residents with certain special eligibility statuses can enroll through OregonHealthcare.gov or apply for a Medicare Savings Program (MSP).
Oregon Health Plan has implemented several cost-containment measures, including limiting beneficiaries to a single pharmacy of their choice, providing case management for clients with specific chronic illnesses, and charging copays for most adult clients who are not part of exempt groups such as tribal members and pregnant women.
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Short-term insurance regulations
In the state of Oregon, short-term health insurance plans are subject to specific regulations that set them apart from traditional health insurance offerings. These regulations have evolved over time, with the state generally moving towards stricter guidelines for short-term coverage.
As of 2024, Oregon law limits the duration of short-term health insurance plans to three months, including any renewals. This means that an individual can only be covered by a short-term plan for a maximum of three months out of the year. This regulation is stricter than the federal guidelines implemented by the Biden administration in 2024, which allow for initial terms of three months and a total duration of up to four months with renewals. However, because Oregon has imposed stricter rules, the state's three-month limit takes precedence.
In addition to the duration limits, Oregon has also enacted disclosure requirements for short-term health plans. Since 2021, insurers have been required to provide enrollees with a disclosure stating that the plan is not regulated by the Affordable Care Act (ACA) and that they may have to wait for the next annual open enrollment period to purchase ACA-compliant coverage. This disclosure is intended to help consumers understand the limitations of short-term plans and make informed decisions about their healthcare coverage.
The state's regulatory body, the Oregon Division of Financial Regulation, has also published guidance to assist consumers in making informed choices about short-term health insurance. They advise individuals to ask a series of questions before enrolling in a short-term plan to ensure they understand the limitations of such coverage and are aware of other available options.
It is worth noting that Oregon has a history of progressive expansion of healthcare coverage. In 1995, the state began to add mental health and chemical dependency coverage to Medicaid, demonstrating an early commitment to comprehensive healthcare for its residents. In 2014, Oregon also accepted federal funding to further expand Medicaid coverage, making it available to all legally present residents with incomes up to 138% of the poverty line.
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Oregon's Medicaid program enrollment
Medicaid in Oregon is called the Oregon Health Plan (OHP). The OHP provides coverage to adults under 65 with household incomes up to 138% of the federal poverty level. This includes adults who were already enrolled in Medicaid before the end of the COVID-related continuous coverage rule, with eligibility temporarily extended to 200% of the poverty level. In July 2024, Oregon will launch a Basic Health Program called OHP Bridge, which will cover people with incomes between 138% and 200% of the poverty level.
Oregon has long accepted federal funding to expand its Medicaid program. In 1995, Oregon's Medicaid program began to add mental health and chemical dependency coverage, although these services were removed from the basic benefits package in 2003. Notably, Oregon expanded basic coverage to everyone living in poverty as early as 1995, while in most states, Medicaid was only available to pregnant women, children, seniors, and adults with disabilities prior to 2014.
The best way to enrol in the Oregon Health Plan is online at One Oregon. Residents with certain special eligibility status can enrol through OregonHealthcare.gov. Additionally, those who are already enrolled in the Oregon Health Plan and Healthy Kids must renew their benefits annually. They will receive a notice from the state when it is time to do so, and the Oregon Health Plan website has renewal forms and full renewal applications available for existing members.
There are several ways to apply for OHP: by calling OHP Customer Service, mailing applications to OHP Customer Service, or receiving in-person assistance from an "Assister" from OHP. Working with an assister offers one-on-one help and takes the least amount of time from application through enrolment.
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Frequently asked questions
Yes, Oregon health insurance does get funding from Medicaid. In 2014, Oregon accepted federal funding to expand its Medicaid program.
Eligibility for the Oregon Health Plan is based mainly on income levels. However, there are other factors that determine eligibility. The best way to find out if you qualify is to apply.
The best way to enroll in the Oregon Health Plan is online at One Oregon. You can begin the process at HealthCare.gov, and will be directed to Oregon Medicaid if it appears that you're eligible.
