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Oregon Health Plan access to health care
Learn more about how OHP clients can access health care services. 
 
If you have questions not answered on this page, go to the Contact Us page and send your question to the appropriate DMAP contact, or contact the appropriate plan.
 

 OHP-Faqs

 
  
Answer
How do I get medical care?

If you are in an OHP health plan (Fully Capitated Health Plan, Physician Care Organization or Coordinated Care Organization), call your plan. If you are not in a plan, call providers in your area and ask if they accept OHP (“open card”); or contact a local safety net clinic:

How do I get dental care?

If you are in an OHP dental care organization or coordinated care organization (CCO - CCOA or CCOG), call your DCO/CCO. If you are not in a DCO/CCO, try these resources:

  •  Insure Kids Now!: Find OHP dentists in your area. Select the "Oregon Health Plan - Fee-for-Service" benefit plan.
How do I get mental health care?

Call your OHP Mental Health Organization or Coordinated Care Organization.

What plans work with OHP?

To find out about the plans in your area, go to the OHP Health and Dental Plans by County page.

How can OHP members find a health care provider?

Members in an OHP plan can call the plan to get a list of providers currently accepting new patients. Some plans have online provider directories.

Members not in a plan must call health care providers directly to find out if they accept OHP (Medicaid) patients.

 

Can members in an OHP plan seek services from a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC)?

Yes, but only when the FQHC or RHC is part of their plan’s provider panel.

What happens when an OHP health plan member seeks services from a provider that has not been authorized by the plan?

OHP plans approve services for their members. They are not obligated to pay providers for care that has not been approved by the plan (unless it is an emergency). This is true even if the provider collected a copayment.

The provider should always ask members for their Oregon Health ID (formerly Medical Care ID) before serving them, then verify eligibility, benefit package and plan enrollment to determine who authorizes services (DMAP or the plan).

For providers, what are the advantages of managed or coordinated care? 
  • Higher reimbursement. Plans usually pay more for services rendered to OHP patients than DMAP does. 
  • Access to highly developed systems. Plans have continuous quality improvement practices. Access to those resources can help providers address issues facing their patients. 
For members, what are the advantages of managed or coordinated care?
  • Access to a network of health care providers. If you’re not in a plan, you must call health care providers yourself to find a provider taking new Medicaid patients. 
  • Access to preventive services. Plans offer prevention programs (e.g., tobacco cessation), which may be easier to access than if you are not in a plan.
  • Increased Quality of Care. Plans have systems for improving the quality of care for all of its members.
How can CCO providers help patients change CCOs in order to continue seeing their chosen provider?

CCO providers can use the process described in the CCO Provider Change Request Guide. This process is only for CCO members to switch CCOs in order to keep their physical health Primary Care Provider.

For any other changes, members should contact their CCO/plan or OHP Customer Service.​