Skip to main content

Oregon State Flag An official website of the State of Oregon »

Oregon Health Authority logo

Oregon Health Plan (OHP) Benefit Update Project

Open for Public Comment

The draft Phase-out Plan for the Waiver Authority Related to the Prioritized List is open for public comment beginning April 15, 2026. Please send written comments by 5 p.m., Friday, May 15, 2026, to 1115waiver.renewal@odhsoha.oregon.gov.

Changing How Oregon Organizes OHP (Medicaid) Benefits

Since 1994, Oregon has used the Prioritized List of Health Services to help determine what OHP covers. This list ranks health conditions and their treatments.  

  • Services that are most effective or most important for overall health rank higher.
  • Services not needed or less effective rank lower.

The Oregon Legislature sets a funding line. This line sets how many services OHP covers on the Prioritized List. Services above the line are covered. Services below the line are usually not covered. This line has not moved since 2012. 

Oregon is the only state that uses a Prioritized List. The Health Evidence Review Commission manages the list. The commission is an independent body that:

  • Looks at the science behind treatments,
  • Decides what treatments are medically necessary, and
  • Gets feedback from members on which services OHP should cover.

Medically necessary means the services are:

  • Needed for diagnosis or treatment and
  • Backed by science.

What Is Changing?

The federal Centers for Medicare & Medicaid Services told Oregon Health Authority (OHA) to phase out the waiver authority related to the Prioritized List by Jan. 1, 2027. Instead, OHA must group services into categories and decide which services to cover. These decisions will be in Oregon's Medicaid State Plan.

  • The federal government sets these categories. It also sets which categories are mandatory and optional.
  • OHP will cover all medically necessary services in covered categories. 
  • Optional categories will clearly list covered and non-covered benefits. 
  • Oregon will decide which new optional benefits to cover.

This matches how other states define Medicaid-covered services.

What This Change Means for OHP Members

Members will not lose benefits because of this change. All services covered today will still be covered on and after Jan. 1, 2027.

  • Starting in January 2027, OHP will cover medically necessary treatments for more health conditions, such as tension headaches and fibromyalgia.
  • OHP will still not cover treatments that are cosmetic or medically unnecessary.
  • OHA or the member's coordinated care organization (CCO) may still need to approve some services.

The Health Evidence Review Commission will still:
  • Review evidence and community input on clinical services,
  • Support public, transparent processes,
  • Seek opportunities for community engagement,
  • Produce guidance on the medical necessity of some services, and
  • Document conditions and their covered treatments.

Health Care Partners: OHA Values and Needs Your Input

OHA will present at regular meetings to:

  • Describe the change to the benefit structure
  • Answer questions about the change
  • Get input about possible impacts to these groups.

​OHA is holding a technical table with the BUP Workgroup members and other partners to discuss the phase out of the waiver authority related to the Prioritized List. 

The meeting recordings can be found below. The information in the meeting materials is current as of the meeting date. Project decisions continue to evolve with health care partner input.

May 11, 2026 Meeting Recording​

Benefit Update Project Workgroup Recommendations (1/6/2026)

​The workgroup has people with many different skills and backgrounds.  They are meeting between August and December 2025 to help plan for stopping use of the Prioritized List.​

​​​Membership

The following people are members of the BUP Workgroup:

Disability Rights Community: Ben Gurewitz, Disability Rights Oregon

Dental Care Organization: Dr. Gary Allen, Advantage Dental

Statewide Behavioral Health Association: Heather Jefferis, Oregon Council for Behavioral Health (Workgroup Co-Chair)

Community-Based Provider: Briana Axline, Community Health Centers of Lane County

Health System: Art Mathisen, Good Shepherd Health Care System

Legal Aid: Bridget Budbill, Oregon Law Center

Health Evidence Review Commission (HERC): Dr. Adriane Irwin

Tribal: Michael Collins, Confederated Tribes of Warm Springs

Coordinated Care Organizations:

  • Erin Fair Taylor, PacificSource Community Solutions
  • Dr. Amy Burns, AllCare
  • Dr. Cat Livingston, Health Share of Oregon (Workgroup Co-Chair)
  • Dr. Jeanne Savage, Trillium Community Health Plan
  • Dr. Mary Engrav, Jackson Care Connect, Columbia Pacific CCO (CareOregon)

Meeting Schedule and Mate​rials

The workgroup meeting schedule and registration links are below. Everyone can listen to the meetings, but only people in the workgroup can talk or join in. 

The information in the meeting materials is current as of the meeting date. Project decisions continue to evolve with health care partner input. 

Wednesday, August 13 from 8:05 to 10:30 a.m. Pacific Time

Tuesday, September 2 from 8:05 to 10:30 a.m. Pacific Time

​Wednesday, September 24 from 8:05 to 10:30 a.m. Pacific Time

​Tuesday, October 14 from 8:05 to 10:30 a.m. Pacific Time

Tuesday, October 28 ​from 8:05 to 10:30 a.m. Pacific Time

Wednesday, November 5 from 8:05 to 10:30 a.m. Pacific Time

Tuesday, November 18 from 8:35 to 11 a.m. Pacific Time

  • Review meeting materials here.

Tuesday, December 2 from 8:35 to 11 a.m. Pacific Time

All Come – Quarterly virtual meeting on the 1st Wednesday of the month at 10 a.m. Pacific Time starting in January. Register here.

Para Todos – Quarterly virtual meeting in Spanish on the 1st Wednesday of the month at 2 p.m. Pacific Time. Register here.

Medicaid Advisory Committee/Advising Consumer Experience subcommittee – Monthly meeting. OHA will provide project updates at one meeting per quarter. View the meeting schedule. 

​Listening Session – OHA held a session Jan. 29, 2025, and may hold another one this year. 

Health Evidence Review Commission – The commission typically meets every 1 or 2 months. View the meeting schedule.

​CCO Quality and Health Outcomes Committee – Monthly meeting. View the meeting schedule.

Office Hours: OHA is holding office hours for CCOs to discuss technical implementation topics.

Ad hoc participation in provider conferences/forums – OHA will make an effort to occasionally attend conferences and forums where discussion about the project is appropriate.

​Health Evidence Review Commission  – The commission typically meets every 1 or 2 months. View the meeting schedule.

​CCO Quality and Health Outcomes Committee – Monthly meeting. View the meeting schedule.

Office Hours: OHA is holding office hours for CCOs to discuss technical implementation topics.

​Legislative updates – Leadership of the 1115 waiver project will provide regular updates to the Oregon Legislature​.

.​All Come – Quarterly virtual meeting on the 1st Wednesday of the month at noon Pacific Time. Register here.

Para Todos – Quarterly virtual meeting in Spanish on the 1st Wednesday of the month at 2 p.m. Pacific Time.  Register here.

Health Evidence Review Commission  – The commission typically meets every 1 or 2 months. View the meeting schedule.

Listening Session Material

OHA held listening sessions from August through November 2024 and January 2025. The 2024 sessions were for community partners, CCOs and fee-for-service (open card) contractors. The 2025 sessions were for health care providers.

The information in this material is current as of the presentation date. Project decisions continue to evolve with health care partner input.


Learn More

Benefit Update Project fact sheet:

Benefit Update Project frequently asked questions

Learn more about the 2022-2027 waiver

Visit the HERC website

Learn more about the Prioritized List of Health Services

Learn more about CCOs

Keep Informed

Sign up for OHA 1115 Medicaid Waiver updates. The waiver lets OHP expand and improve health care throughout Oregon.

Questions or Comments?

Media questions: Kristen Lambert, OHA Communications

Other questions: Email us