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Oregon Health Plan 1115 Demonstration Waiver

Overview

Section 1115 Medicaid Demonstrations give states flexibility to design and improve programs and to show how new policy approaches such as eligibility expansion, service expansion or using innovative service delivery systems can improve care, increase efficiency, and reduce costs.

Under 1115 authority, states may receive approval to waive some requirements of their Medicaid or CHIP state plans to test new approaches to paying for and delivering covered services and defining or limiting benefit packages.

Oregon's initial 1115 Medicaid Demonstration waiver established the original groundbreaking Oregon Health Plan (OHP) in 1994. Since then, the Demonstration has given Oregon numerous opportunities to expand and improve health care throughout the state.

1994: Established the Oregon Health Plan (OHP). This made most people living in poverty eligible for Medicaid, regardless of age, disability or family status. It also based coverage on the Prioritized List of Health Services​​. This list defines the health condition and treatment pairs that OHP covers in priority order.

1997: Gave Children’s Health Insurance Program (CHIP) members the same benefits and delivery system as Medicaid members.

2002: Established OHP Plus and OHP Standard benefits. Added the Family Health Insurance Assistance Program.

2007 and 2009: Expanded CHIP and established the Healthy Kids program.

2012: Established the coordinated care model and initiated Health System Transformation.

2017: Builds upon Oregon’s Health System Transformation​.​

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Oregon's Current Demonstration

Oregon's current OHP 1115 Medicaid Demonstration runs from Jan. 12, 2017, through Sept. 30, 2022. It continues and expands all of the elements of the 2012 waiver, particularly around integration of behavioral, physical and oral health integration, and include a focus on social determinants of health, population health, and health care quality.

​The 2017-2022 renewal builds on the foundation of Oregon's health system transformation. It promotes a performance-driven system to improve health outcomes and bend the cost curve. It includes:
  1. An expanded focus on the integration of physical, behavioral, and oral health care.
  2. A strong focus on social determinants of health and health equity to improve population health outcomes for all low-income Oregonians.
  3. A commitment to an ongoing sustainable rate of growth. The 2-percent test puts the federal investment at risk for not meeting that target. CCO payment and contracting protocols promote increased investments in health-related services and use of value-based payments.
  4. Expanding the coordinated care model with innovative strategies for ensuring better outcomes for members eligible for both Medicare and Medicaid.​​


​​OHA accepted written comments through June 1, 2016. To collect written comments, OHA:

  • Sent newsletters, emails, and public meeting notices to Tribes and stakeholders. 
  • Published notices on the OHA and Secretary of State websites.
  • Offered an online survey to submit comments.
OHA also held many meetings and public hearings with stakeholders, Tribal government leaders and the public.

OHA public notices:

​The Special Terms and Conditions (STCs) of an approved 1115 waiver list:

  • ​The waivers needed to perform the demonstration;
  • How the state may pay for new items, programs or services permitted under the demonstration;
  • The federal matching funds the state will receive for covering the new items, programs or services;
  • Other state requirements related to rate setting, performance measures, quality improvement, reporting, and more.

Oregon's Waiver Renewal Application (2022-2027)

In February 2022, the Oregon Health Authority submitted the final application to CMS, whose approval is needed to implement policies reflected in the application. If approved, Oregon would make changes to OHP during the 2022 – 2027 demonstration period. 

Visit the 2022-2027 Waiver Renewal page for an in-depth look at:

  • The policy proposals
  • Waiver impact issue briefs
  • The draft application, public notice, summary of how public input was collected, and all public comments received by OHA
  • The final application submitted to CMS