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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, which made Medicaid available to most people living in poverty regardless of age, disability or family status; and based benefit coverage on prioritized health care conditions and treatments (the Prioritized List of Health Services​).

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

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

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

2012: Implemented 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 January 12, 2017 through June 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 renewal that was approved by CMS reflects Oregon's vision to build on the foundation of Oregon's health system transformation, including:
  1. An expanded focus on the integration of physical, behavioral, and oral health care through a performance driven system that makes continual improvements to health outcomes and continues to bend the cost curve.
  2. A strong focus on social determinants of health and health equity across all low-income, vulnerable Oregonians with the goal of improving population health outcomes.
  3. A commitment to an ongoing sustainable rate of growth that includes the 2 percent test, putting the federal investment at risk for not meeting that target and adopting a payment methodology and contracting protocol for CCOs that promotes increased investments on health-related services and advances the use of value-based payments.
  4. Continuing to expand the coordinated care model, including innovative strategies for ensuring better outcomes for members eligible for both Medicare and Medicaid.​

​Written comments through June 1, 2016. Newsletters, emails, and public meeting notices were sent to Tribes and stakeholders, and notices were published on the OHA and Secretary of State’s websites soliciting written comments.

  • An online survey was available to provide comments.
  • Numerous face-to-face meetings and public hearings were held with stakeholders, Tribal government leaders and the public.

Notices were sent out via:


​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.

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