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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 2022 CCO capitation rates 

October 7, 2021

The Oregon Health Authority has finalized the 2022 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). In 2022, the rates will be 4.2% higher than in 2021.

The rate increase for 2022 begins with the legislatively budgeted 3.4 percent baseline growth rate combined with additional funding for a program enhancement (+0.8 percent) to improve service delivery for members with substance use disorders, resulting in a 4.2 percent total growth for 2022 from 2021. The program enhancement is related to an approved 1115 Demonstration waiver regarding substance use disorders, which was effective April 8, 2021.

The average net per-member-per-month payment in 2022 will be $485.84, which is approximately 4.2 percent more than the comparable average per-member-per-month payment in 2021.


2018-2022 Capitation Rate Reports

2018-2022 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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