The Oregon Health Plan (OHP) is Oregon's state Medicaid program, designed to provide comprehensive health coverage to eligible residents. It encompasses many services, including primary care, hospital care, dental health, mental health services, and prescription medication coverage. OHP is for low-income individuals and families, older adults, pregnant women, and people with disabilities, with eligibility based on income and other factors. The program aims to ensure accessible and affordable healthcare for its members, supporting their overall health and well-being.

The Oregon Health Plan (OHP) Open Card offers a comprehensive range of services. Here's a summary of the key benefits:

1. Primary Care: Includes services from doctors, nurse practitioners, physician's assistants, and naturopaths for checkups and when you're sick. Referrals to specialists are also part of this.
2. Hospital Care: Covers emergency and scheduled surgeries, emergency room visits, transplant care, emergency behavioral health care, and transfer to other facilities for additional care. Prior authorization is not required for emergency hospital care, though some scheduled surgeries and transplants might need it.
3. Vision Care: Generally, OHP does not cover services to correct vision, like eye exams and glasses, except under certain conditions. Coverage includes glasses or contact lenses for those with a medical eye condition or post-cataract surgery, children under 21, and pregnant members. Routine eye exams are covered every 24 months for members aged 21 or older with the Open Card OHP Plus benefit package.
4. Dental Health: Covers urgent and emergency dental needs, cleanings, X-rays, exams, fluoride varnish applications, fillings, extractions, crowns (for specific groups), root canals, dentures, and some specialty dental care with a referral.
5. Behavioral Health: Includes treatment for mental health conditions and substance use disorders. Services cover care coordination, case management, emergency services, evaluations, hospital stays, medication management, peer-delivered services, residential treatment, and therapy. Specific treatments for substance use disorders like methadone and Suboxone are also covered.
6. Wraparound Services for Children and Families: These are intensive services for children and youth up to age 17 involved in multiple systems (like foster care or juvenile justice) and are facing mental health or substance use issues.
7. Prior Authorization for Services and Medicine: Some services and medicines require prior authorization. This is where your healthcare provider must send information to OHP before the plan pays for your services or medicine.
8. Medications: Covers mental and physical health medications. Members with Medicare Part D or private health insurance are billed first. OHP helps with copays and covers medications not covered by other plans.
9. Health-Related Social Needs Services (HRSN): Starting from various dates in 2024 and 2025, OHP plans to introduce services addressing barriers to health, like lack of housing or access to food. This includes climate, housing, and nutrition services for eligible members.

Ask your provider or coordinated care organization (CCO) to determine if OHP covers a specific service.

The Oregon Health Plan (OHP) eligibility requirements are based on various factors, including income, residency, age, and disability status. Here's a summary:

1. Income and Residency Requirements: Individuals and families must meet specific income thresholds and residency requirements and be Oregon residents to qualify. These income limits are updated annually. View this chart for the latest income limits.
2. Application Process: The best way to determine eligibility is to apply for OHP. You can use this tool to enter household income, ages, and other relevant information to see if applying for OHP is right for you.
3. Specific Groups: People may also qualify based on age and disability status. Older adults and individuals with disabilities have distinct processes for application and eligibility determination. They should contact the Aging and Disability Resource Connection (ADRC) at 1-855-ORE-ADRC (855-673-2372) for assistance.
4. Income Limits: The income limits for OHP change every year and are detailed in a specific chart. Additionally, rules outline how OHP uses income information to make eligibility decisions.
5. Complex Cases: The requirements for older adults and people with disabilities are more complex. For detailed information, it is recommended to contact the ADRC.

Eligibility criteria can be complex and are subject to change. Hence, consulting the latest resources or directly contacting the relevant authorities (like ADRC or OHP) is advisable for the most accurate and up-to-date information.

Applying for the Oregon Health Plan (OHP) can be done through several methods, ensuring accessibility for different needs and preferences. Here's how you can apply:

Online Application

You can apply online through the Oregon Eligibility (ONE) portal. This method is often the quickest, allowing you to track your application status.

Paper Application

If you prefer, you can fill out a paper application. You can download and print the application form from the OHP website or get a copy from a local office. Once completed, you can mail or fax the application to the address or fax number provided on the form.

In-Person Assistance

You can apply in person by visiting a local Oregon Department of Human Services (ODHS) office. There, you can get assistance with the application process. Additionally, trained community partners are available throughout Oregon to help with applying. They can provide one-on-one assistance and answer any questions you may have.

Telephone Application

You can also apply over the phone by calling the OHP Customer Service at 1-800-699-9075. This method is useful if you need guidance through the application process or have specific questions.

Application Assistance for Special Groups

For older adults and people with disabilities, specific assistance is available. They are encouraged to contact the Aging and Disability Resource Connection (ADRC) for tailored support.

Required Information

When applying, be ready to provide personal information such as your Social Security number, income details, and any current health insurance information.

Review and Submit

Ensure all information is accurate and complete before submitting your application. Inaccurate or incomplete applications can delay the process.

After submitting your application, OHP will review it to determine your eligibility. You will receive a notification about your eligibility status and, if eligible, information about your coverage.

Renewing your Oregon Health Plan (OHP) coverage involves verifying your continued eligibility for the program. Here's a summary of the key points regarding OHP renewal:

OHP renewals, which resumed on April 1, 2023, are a part of assessing eligibility for the COVID-19 Public Health Emergency.

OHP will send members a letter detailing the steps required to renew their OHP coverage.

It's crucial to keep your contact information updated with OHP to ensure you receive renewal letters. Changes can be reported on the OHP's Report Changes page.

Members can also view their OHP letters online through their Oregon Eligibility (ONE) account. Instructions for using ONE are available on the OHP website.

Trained community partners are available to assist with the renewal process, free of charge. Members can find a community partner in their area through OregonHealthCare.gov. Alternatively, ONE Customer Service can be contacted at 800-699-9075 (TTY: 711) for assistance.

If you don't respond to the renewal letter, OHP will send reminder letters 60 and 30 days before the 'respond by' date. If there's still no response, a close notice will be sent 60 days before the scheduled end of benefits, followed by a notice when benefits end. Members have 90 days from receiving the end notice to respond and renew their coverage. After 90 days, a new application for OHP is required.

If you think your OHP coverage was mistakenly denied, contact ONE Customer Service or your local ODHS office to update your information and reassess your eligibility. If you still believe you qualify after ensuring your information is correct, you can request a hearing to review the decision.