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Background on Oregon's 1115 Medicaid Demonstration Waiver

Waiver Background

Under 1115 authority, a state may obtain approval for experimental, pilot, or demonstration projects that promote the objectives of the Medicaid and CHIP programs, and waive some requirements of the Medicaid or CHIP state plan, to test new approaches to:
  • Paying for and delivering Medicaid-funded services; and
  • Defining and limiting benefit packages.

Read the 1115 Waiver Fact Sheet

Special Terms and Conditions Overview

The Special Terms and Conditions (STCs) of an approved 1115 waiver list:
  • The waivers necessary to establish and maintain Oregon’s transformed health care system under the demonstration;
  • The specific expenditures CMS will allow the state to make, with federal matching funds included, on items, programs or services now permitted under the demonstration; and
  • All other state obligations under the demonstration, such as rate setting, complaints and grievances monitoring, training activities under the Transformation Center, and more.

Oregon’s Waiver History

Oregon has had a waiver since 1994. In 2012 the waiver implemented the coordinated care model and initiated Health System Transformation. Oregon's goal is to continue to build on the model .
  1. 1994: Oregon Health Plan created through a waiver with CMS.
  2. 1997: Children’s Health Insurance Program incorporated, providing eligible CHIP members same benefits and delivery system as Medicaid members.
  3. 2002: Established OHP-Plus and OHP-Standard benefits and included the Family Health Insurance Assistance Program.
  4. 2007 & 2009: Expanded CHIP and created Healthy Kids program.
  5. 2012: Established Oregon’s Health System Transformation.
  6. 2017: Build upon Oregon’s Health System Transformation.

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