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Your Rights as an Oregon Health Plan Member

Learn your rights and what to do if you do not agree with decisions, services or treatment you receive as an Oregon Health Plan (OHP) member.

OHP rights and responsibilities

These Oregon Administrative Rules list the rights and responsibilities you have as an Oregon Health Plan (OHP) member:

  • 410-120-1855 – For all OHP members
  • 410-141-3590 – For all OHP members in coordinated care organization or other managed care entity

Your rights

Disability rights

The Americans with Disabilities (ADA) law makes sure that people with disabilities get full and equal access to health care services and facilities. People with disabilities have a right to reasonable changes to gain equal access.

Non-discrimination and civil rights

OHP must respect the dignity and the diversity of all members and the communities where they live. By law, OHA and all its providers and plans must treat everyone fairly. To learn more, visit OHA’s Civil Rights page.

Language access

Everyone has a right to learn about Oregon Health Authority (OHA) programs and services in a way they can understand. To learn more, read OHA’s Language Access policy.

Rights of minors

Minor Rights and Access to Care (English) (Spanish) tells you the types of services minors can get on their own, and how their health information may be shared.

Complaints and appeals

Learn what to do when you:

  • Do not agree with a decision to deny payment for your health care services
  • Want to file a complaint about OHP services
  • Want to file a complaint about an Emergency Medical Services provider, Trauma Systems provider, or health care facility

Making decisions about your health care

There are three types of forms you can complete to make sure providers know about the types of treatment you do and do not want:

Advance directive

This form lets you decide what type of care you want before you need it. You can also name a person to direct your health care. This person is called your "health care representative."

Physican Orders for Life-Sustaining Treatment (POLST)

This is a medical order completed by your doctor. It tells other providers the types of treatment you do and do not want in an emergency.

Declaration for Mental Health Treatment

This form tells what kind of mental health treatment you want if you cannot make decisions during a mental health crisis. You can also name a person to make decisions about your treatment.

Your responsibilities

Payment recovery

When OHP pays for services that another resource should have covered, the Office of Accuracy and Payment Recovery collects those payments. Clients must report all health coverage resources to make sure OHP only pays after other resources have paid.

  • Estate recovery: After an OHP member dies, OHA will ask to be paid back for services that OHP covered after age 55 for people in long-term care. This applies only when OHP has paid some or all of the cost of a member's long-term care using Medicaid funds. To learn more, read the Estate Recovery Program brochure (MSC 9093).
  • Personal injury or accidents: Report current personal injury claims or your intent to file a claim at www.reportinjury.org. Also report the injury to your CCO.
  • Third party liability: Report any other health coverage, such as private health insurance, at www.reportTPL.org.  

Report changes

Report changes to your name, address, household, income or immigration status as soon as possible. Learn about the types of changes to report.

Report Medicaid fraud

If you think an Oregon Health Plan (Medicaid) member or provider is misusing Medicaid/Oregon Health Plan programs and benefits, report it right away.

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