Oregon Medicaid Office

Oregon Health Plan (OHP) and the Oregon Health Authority

Oregon Health Plan (OHP) is the state's combined Medicaid and Children's Health Insurance Program, and as of July 1, 2023, eligibility opens to people of any age or immigration status who meet the income standard — a wider net than most state Medicaid programs throw. OHA itself describes OHP coverage as medical, dental, prescription, and behavioral health care at no cost to members.

Who runs OHP and where it sits in state government

OHP is administered by the Oregon Health Authority (OHA), with the Oregon Department of Human Services (ODHS) handling much of the eligibility and intake work alongside OHA's central operations. Most members are enrolled in a regional Coordinated Care Organization (CCO) that manages their physical, behavioral, and dental care under one budget. CCOs replaced the traditional MCO model in Oregon and remain the primary care system for OHP.

How to reach OHP

• OHP member questions — call OHP Client Services at 1-800-273-0557 or email through the OHP contact page.
• To apply for OHP — call ONE Customer Service at 1-800-699-9075 (open 7 a.m. to 6 p.m. Pacific Time, Monday through Friday) or apply online at ONE.Oregon.gov.
• Mail OHP paperwork — PO Box 14015, Salem, OR 97309.
• Fax — 503-378-5628.
• Talk to your CCO — once enrolled, your CCO is the first stop for finding providers, scheduling care, and asking coverage questions.

Enrollment is always open for OHP, which is unusual for state programs that use Medicare- or marketplace-style annual enrollment windows. You can apply at any time of year.

Who qualifies for OHP?

OHA frames OHP eligibility around two basic gates: income and residency. The agency lists the detailed rules in its Oregon Administrative Rules (OAR) Division 200 chapter and points applicants to the online prescreening tool at ohim.checkbookhealth.org. People may also qualify based on age and disability status — those applicants are routed through Oregon's Aging and Disability Resource Connection (ADRC) at 1-855-ORE-ADRC (855-673-2372).

OHP's three benefit packages

OHA structures OHP coverage in three tracks:

• OHP Plus — for children ages 0–18 and adults ages 19–64; the full benefit package most members use.
• OHP Plus Supplemental — for pregnant adults age 21 or older; layered on top of the standard pregnancy track.
• OHP with Limited Drug — for adults who qualify for both Medicaid and Medicare Part D; provides full medical, dental, and behavioral health coverage with drug coverage routed through Medicare.

Two narrower programs sit alongside OHP: OHP Dental, a dental-only benefit for Oregon veterans and Compact of Free Association (COFA) citizens, and the Qualified Medicare Beneficiary program for low-income Medicare enrollees who don't need the full OHP benefit.

The July 2023 expansion

OHA opened full OHP benefits to people of any age or immigration status effective July 1, 2023. Oregon was an early adopter of ACA expansion; the 2023 change added income-eligible residents who would have been excluded from federal Medicaid because of immigration status. The expansion is administered as part of the standard OHP track, with the same eligibility test and benefit package.

Presumptive Medical Eligibility

Applicants who visit a qualified hospital can get a same-visit determination through Presumptive Medical Eligibility — a temporary OHP coverage window that buys the household time to complete the full application.

Renewal cadence and reporting changes

OHP renews coverage every two years for members age six or older — twice the typical Medicaid 12-month cadence. When OHA needs more information to renew, the agency sends a letter; members must respond by the printed deadline. Changes to income, household size, pregnancy, or moves must be reported within 10 days through the ONE portal.

OHP income limits

OHA does not republish OHP income dollar limits on its eligibility page. It is direct about why: income limits change every year as the federal poverty level updates each January. The agency points applicants to its OHP income chart and to OAR 410-200-0310, the rule that explains how OHP applies income to eligibility decisions.

How to check the current OHP income standard

• OHP income chart — published by OHA at sharedsystems.dhsoha.state.or.us/DHSForms/Served/de5530.pdf; this PDF lists current monthly and annual limits by household size and program track.
• Online prescreening tool — ohim.checkbookhealth.org lets you enter household income, ages, and other facts and see whether applying for OHP is likely to succeed.
• OAR Division 200 — the binding administrative rules for OHP eligibility, including OAR 410-200-0310 (income) and OAR 410-200-0200 (residency).

If you fall above the OHP income cut-off

OHP applicants who don't qualify can still submit a single application at Healthcare.gov for federally subsidized marketplace coverage. ADRC at 1-855-ORE-ADRC handles a different track for older adults and people with disabilities — the rules there are more complex and not based purely on percentage-of-FPL math, so the agency recommends calling ADRC for a screening rather than reading the chart alone.

Medicare Savings Programs and dual-eligible coverage

Adults who already have Medicare and don't qualify for full OHP may still qualify for the Medicare Savings Programs, which pay Medicare premium costs. Adults who qualify for both Medicaid and Medicare Part D use the OHP with Limited Drug track, which gives them OHP medical, dental, and behavioral health benefits while drug coverage runs through Medicare.

How to apply for OHP

One OHP application also screens the household for SNAP, TANF, and child care benefits through the same ONE portal. Most applicants finish online in one sitting; the phone, paper, and in-person tracks all run through the same back-end system.

Three ways to apply

• Online at ONE.Oregon.gov — create a ONE account, click "Apply Now," and upload your supporting documents.
• By phone — call ONE Customer Service at 1-800-699-9075 (7 a.m. to 6 p.m. Pacific Time, Monday through Friday). ONE technical support is at 1-833-978-1073. TTY users dial 711.
• In person — visit a local Oregon Department of Human Services (ODHS) office or an OHP-certified community partner. Community partner help is free.

Paper application in 16 languages

If you prefer paper, OHA publishes the OHP application (form HE 7210) in English, Spanish, Russian, Vietnamese, Simplified Chinese, Traditional Chinese, Somali, Arabic, Farsi, Dari, Pashto/Pashtu, Korean, Kosraean, Palauan, Pohnpeian, Chuukese, and Marshallese. The agency also publishes a separate application guide in most of those languages.

How long does a decision take?

OHA's published rule of thumb is up to 45 calendar days after ODHS receives your completed application. Disability-based decisions can take longer because they require additional medical determination. If you applied online, your application status appears in the ONE dashboard; phone and mail applicants can check by calling ONE Customer Service.

What ONE will ask for

You will need name, date of birth, Social Security number (for everyone who has one), contact information with a valid mailing address, proof of naturalization or immigration status, income, expenses and tax deductions for everyone on your federal tax return, and any other health coverage you currently carry (Medicare, private insurance). If your household had Medicaid in another state, OHA notes that Medicaid benefits do not travel between states — you have to apply fresh in Oregon.

Apply at any time of year

Unlike Medicare or marketplace plans, OHP has no annual open enrollment window. The portal accepts applications year-round; coverage starts back to the first day of the application month for households whose eligibility is confirmed.

What OHP covers

OHA structures OHP coverage in 15 named service categories plus a separate Health Related Social Needs (HRSN) benefit track. Children under 21 fall under EPSDT — a federal mandate that overrides the adult coverage filter — and pregnant members get full coverage regardless of the Prioritized List rules that govern adult care.

What OHP covers

OHA's Benefits page lists the following categories of care, each linking out to its own benefit summary:

• Behavioral health care
• Care coordination
• Dental care
• Diagnostic and preventive care
• Emergency care and urgent care
• EPSDT (care from birth to age 21)
• Eye and vision care
• Gender-affirming care
• Medical care
• Pregnancy care
• Prescriptions
• Reproductive and sexual health
• Telehealth
• Travel help (non-emergency medical transportation)

The Prioritized List of Health Services

For adults age 21 and over, OHP coverage of a specific service depends on two things: whether the service is in the member's benefit package and whether the Prioritized List of Health Services funds the condition/treatment pair. Children under 21 are exempt from the Prioritized List — EPSDT requires coverage of any medically necessary service for a child.

Health Related Social Needs (HRSN) benefits

Some OHP members facing certain life changes qualify for HRSN benefits beyond standard medical coverage. The two named HRSN tracks are Housing benefits and Nutrition benefits. CCOs may also offer flexible services — items or services that are not regular OHP benefits but help keep members healthy or help them get healthier.

Getting started with your CCO

OHA's three-step onboarding for new OHP members is straightforward: get to know your Coordinated Care Organization (CCO), pick a provider, and make an appointment. CCOs deliver almost all OHP care. If you are not assigned to a CCO, call OHP Client Services at 1-800-273-0557 for help connecting.

OHP Dental and Qualified Medicare Beneficiary

OHP Dental is a dental-only program for Oregon veterans and Compact of Free Association (COFA) citizens. The Qualified Medicare Beneficiary (QMB) program is different: it does not cover health care directly — it only covers Medicare premiums and copayments (except for Medicare Part D) and deductibles.

Other state Medicaid pages