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OHP Rate Development

Overview

The Oregon Health Plan (OHP) is our state Medicaid program. It provides health coverage for low-income Oregonians that include working families, children, pregnant women, single adults, seniors and more. The Oregon Health Authority (OHA) has contracted with a variety of health entities, known as Coordinated Care Organizations or CCOs, to manage and deliver health care for most of these people eligible for Medicaid. 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 and is paid to CCOs on a monthly basis dependent on enrollment. 

These capitation rates are developed and certified by OHA's contracted actuaries on a yearly basis. The process and methodology used to develop capitation rates are governed by federal and state regulations. CMS requires Oregon's capitation rates be Actuarially Sound and follow applicable Actuarial Standards of Practice, which are developed by the Actuarial Standards Board

OHA releases 2020 CCO capitation rates 

October 7, 2019

OHA has finalized the 2020 capitation rates for CCOs. These rates are the per-member-per-month amounts the state pays CCOs to coordinate health care for OHP members. The average net payment in 2020 is approximately $471. The 2020 rates include multiple budget-neutral adjustments such as the inclusion of the quality pool program within the rates and a change in how hospitals are reimbursed. These changes impact comparisons between 2019 and 2020 rates. The overall rate increase meets the 3.4 percent rate-of-growth target for state general funds.
 
Due to the passage of HB 2267 in the Legislature’s 2019 session, 2020 rates will be recalculated in summer 2020 and be applied retroactively to January 2020. The recalculation is intended to account for any changes to CCO member enrollment during the transition from 2019 to 2020 contracts.

 

2016-2020 Capitation Rate Reports

2016-2020 Contract Rate Sheets

Questions?

Please contact:
Actuarial Services


For more information

  
American Academy of Actuaries
CMS Medicaid Home
Coordinated Care Organizations
Forecasting Reports
Health Evidence Review Commission (HERC)
Oregon Health Plan

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