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Background on Oregon's 1115 Medicaid Demonstration Waiver

Waiver Background

An 1115 waiver allows states to conduct demonstration projects outside of some of the parameters of their approved state plans. Under 1115 authority, a state may obtain approval for experimental, pilot, or demonstration projects that promote the objectives of the Medicaid and CHIP programs.

A Demonstration may allow the State to:

  • Test new approaches to paying for and delivering Medicaid-funded services; and
  • Test new approaches to defining and limiting benefit packages

Special Terms and Conditions Overview

The Special Terms and Conditions (with waivers and expenditure authorities are often referred to as “The Waiver.” The STCs contain:

  • A listing of the Waivers of federal law or regulation that are necessary to establish and maintain Oregon’s transformed health care system under the approved section 1115 Medicaid Demonstration;
  • A listing of the specific Expenditures CMS will allow the state to make, with federal matching funds included, on items, programs or services that were not previously allowed, but are permitted under the Demonstration; and
  • The numerous Special Terms and Conditions that CMS requires that Oregon meet to fulfill the State’s obligations under the Demonstration, including a wide range of topics, from rate-setting, to complaints and grievances, to training activities under the Transformation Center, and much more.

Oregon’s Waiver History

Oregon has had a waiver since 1994 and in 2012 the waiver implemented the 16 CCOs and initiated Health System Transformation Our goal is to continue to build on the model through this renewal waiver period.

  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.

Current Waiver

In July 2012, the Centers for Medicaid and Medicare (CMS) approved Oregon's 1115 Medicaid Demonstration that was necessary to implement health system transformation for the Oregon Health Plan. This waiver was for a five-year period, running from July 2012 through June 2017. Oregon and CMS hope to continue this work with a further waiver renewal and amendment for another five-year period from July 1, 2017 through June 30, 2022.

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