Current Demonstration
Oregon's current Substance Use Disorder (SUD) 1115 Medicaid Demonstration runs from April 8, 2021, through March 31, 2026.
Virtual Public Forum on May 27, 2025
Oregon Health Authority (OHA) is seeking public comment on the progress of the current demonstration:
To learn more, read the public notice from OHA.
Background
A central part of the waiver focuses on enhancing residential treatment services as a crucial component in the continuum of substance use addiction benefits. It accomplishes this by permitting Oregon to receive federal funding for Medicaid services for individuals with an SUD in residential treatment facilities with more than 16 beds.
This new federal funding, added to the resources provided in the Governor’s Budget for 2021-23, allows for greater investment in Oregon’s vision to prevent, identify, and treat people with substance use disorder and help them sustain long-term recovery.
The other major component of this waiver increases the service array for Oregon Health Plan (OHP) members with substance use disorders, including Community Integration services composed of housing and employment support.
At the guidance of CMS, the proposed Recovery Support Services were separated out from this waiver. This means peer-delivered services outside of a treatment episode will be considered for further conversation and development in the future.
For additional information or inquiries, please contact Jennifer Poore, SUD Policy Analyst.
We believe substance use disorder is a chronic condition that needs long-term comprehensive care and support. Oregon envisions a person-centered and recovery-oriented system that supports prevention, treatment and ongoing support for sustained recovery. Before this demonstration:
- Oregon could not use Medicaid funds to pay for residential treatment in facilities with more than 16 beds. Most of Oregon’s residential treatment facilities are more than 16 beds and solely state-funded.
- Only treatment was eligible for Medicaid funding (not prevention, outreach, or recovery support).
The SUD 1115 waiver would allow Oregon to pay all residential facilities using Medicaid funds. OHA will use these new funds to also provide the supports needed to prevent substance use disorder, identify substance use disorder and sustain long-term recovery.
ASAM Implementation
The waiver requires Oregon’s SUD continuum of care to be based on the American Society of Addiction Medicine (ASAM) Criteria and/or other nationally recognized assessment and placement tools that reflect evidence-based clinical guidelines.
The waiver also requires Oregon to establish residential treatment provider qualifications regarding types of services, hours of clinical care, and credentials of staff that meet program standards in The ASAM Criteria.
Rate increases
The waiver and related
State Plan Amendment allow OHA to use federal matching funds to reimburse for residential SUD treatment services, effective Jan. 1, 2022.
Community Integration Services
The waiver also allows Oregon to include Community Integration Services (CIS) as an Oregon Health Plan benefit for eligible members, effective Jan. 1, 2022. CIS comprises:
- Housing support services such as locating and maintaining housing, and
- Employment supports services such as skill building, job search, and maintaining employment.
These services are to help members with an SUD diagnosis who meet qualifying needs-based criteria. The services help transition these members transition back into the community from an inpatient or residential setting.
The Community Integration Services Guide (June 2022) provides more detail about this benefit.
OHA requested and received approval for this amendment upon advisement from CMS on how to modify a risk mitigation arrangement with coordinated care organizations after the applicable rating period has begun in order to make appropriate equitable payments during the COVID-19 Public Health Emergency.
Waiver Extension Application
OHA has requested a five-year extension of the SUD 1115 Demonstration. To learn more about the goals of the extension, visit the SUD Waiver Application page.