Overview
The Oregon Health Authority (OHA) contracts with coordinated care organizations or CCOs. CCOs manage and deliver health care for most people eligible for the Oregon Health Plan (OHP). OHA pays CCOs to cover these individuals with capitation rates.
- Capitation rates are a predetermined payment that depends on the individual's OHP eligibility status.
- OHA pays capitation rates to CCOs on a monthly basis dependent on enrollment.
OHA's contracted actuaries develop and certify CCO capitation rates on a yearly basis. Federal and state regulations govern the process and methodology used to develop capitation rates. The Centers for Medicare & Medicaid Services (CMS) requires Oregon's capitation rates be actuarially sound and follow applicable Actuarial Standards of Practice developed by the
Actuarial Standards Board.
2019-2024 Capitation Rate Reports
2019-2023 Contract Rate Sheets
Dental Distribution Plan Summary
Sentate Bill 5561 (2021) appropriates $19 million General Fund to OHA for a one-time increase in payments to dental care providers to support costs associated with maintaining access and service levels for medical assistance program enrollees.
- OHA has distributed this funding, using a methodology recommended by dental care and coordinated care organizations.
- Below are the follow-up reports summarizing how the funds were spent to meet the intent of appropriation.