About Medicaid and the Oregon Health Plan
Medicaid is a national program. It provides free or low-cost health care to people of all ages with limited income and resources. It helps people and families who need help paying for medical or long-term care. Across the United States, Medicaid covers 92 million people.
Each state has its own Medicaid program. Program names are different from state to state. For example, Washington's program is Apple Health. California's plan is Medi-Cal. Oregon's program is the Oregon Health Plan (OHP). OHP covers 1.48 million (or one in three) Oregonians..
What is a Medicaid Waiver?
Every state must operate according to rules set by the federal government. But states can ask the federal government for permission to not follow some rules. To do this, states must apply for a waiver.
Approved waivers are also called
Section 1115 Medicaid Demonstrations. Demonstrations are a way for states to test new ways to:
- Cover more people,
- Cover benefits,
- Pay for covered services, or
- Deliver care.
Oregon's first OHP 1115 waiver established OHP in 1994. Since then, the OHP 1115 Demonstration has given many opportunities to expand and improve health care throughout Oregon.
Oregon's Current Demonstration
Oregon's current OHP 1115 Medicaid Demonstration runs from Oct. 1, 2022, through Sept. 30, 2027. It advances OHA's goal of eliminating health inequities by 2030, exploring different ways to affect health outcomes for communities and groups that have been disproportionately affected by health inequities in our state..
Oregon's Waiver History
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.
The 2017-2022 OHP 1115 Medicaid Demonstration ran from Jan. 12, 2017, through Sept. 30, 2022. It continued and expanded all 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.
It promotes a performance-driven system to improve health outcomes and bend the cost curve. It includes:
- An expanded focus on the integration of physical, behavioral, and oral health care.
- A strong focus on social determinants of health and health equity to improve population health outcomes for all low-income Oregonians.
- 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.
- Expanding the coordinated care model with innovative strategies for ensuring better outcomes for members eligible for both Medicare and Medicaid.
2017-2022 waiver approval
2017-2022 waiver evaluation
Public input for the 2017-2022 waiver application
OHA accepted written comments through June 1, 2016. To collect written comments, OHA:
- Sent newsletters, emails, and public meeting notices to Tribes and partners.
- 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 partners, Tribal government leaders and the public.
OHA public notices: