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Oregon Health Authority

OHP Rate Development

Overview

The Oregon Health Authority (OHA) contracts with coordinated care organizations or CCOs. CCOs manage and deliver health care for most people eligible for the Oregon Health Plan (OHP). OHA pays CCOs to cover these individuals with capitation rates. 

  • Capitation rates are a predetermined payment that depends on the individual's OHP eligibility status.
  • OHA pays capitation rates to CCOs on a monthly basis dependent on enrollment. 

OHA's contracted actuaries develop and certify CCO capitation rates on a yearly basis. Federal and state regulations govern the process and methodology used to develop capitation rates. The Centers for Medicare & Medicaid Services (CMS) requires Oregon's capitation rates be actuarially sound and follow applicable Actuarial Standards of Practice developed by the Actuarial Standards Board.

Medicaid Capitation Rate Reports

Healthier Oregon Capitation Rate Reports

Basic Health Program Capitation Rate Reports

Health-Related Social Needs

Contract Rate Sheets

Questions?

Please contact:
Actuarial Services

Updates

OHA releases 2024 CCO capitation rates (10/17/2023)

2024 Aggregate CCO Rate Comparison (8/4/2023)

Learn More:

  
American Academy of Actuaries
CMS Medicaid Home
Coordinated Care Organizations
Forecasting Reports
Health Evidence Review Commission (HERC)
Oregon Health Plan