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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 2021 CCO capitation rates 

October 23, 2020

The Oregon Health Authority has finalized the 2021 capitation rates for coordinated care organizations (CCOs). These rates are the per-member-per-month amounts the state pays CCOs to coordinate health care for Oregonians who are members of the Oregon Health Plan (OHP). The rate increase represents a 3.4 percent rate-of-growth for 2021.

The average net payment in 2021 is approximately $467, which is approximately 3.4 percent more than the comparable average per-member-per-month payment in 2020.
 
Due to the passage of HB 2267 in the Legislature’s 2019 session, 2020 rates were recalculated this summer and were applied retroactively to January 2020. The recalculation accounts for changes to CCO member enrollment during the transition from 2019 to 2020 contracts, as well as the unexpected increase in the OHP population due to the public health emergency and the limits the federal government put on Medicaid disenrollment.
 

2017-2021 Capitation Rate Reports

2017-2021 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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