OHP is Oregon's Medicaid program, run by the state instead of the federal government

OHP stands for Oregon Health Plan. It is Oregon's version of Medicaid — the joint federal-state health insurance program for people with low income. Oregon operates its own Medicaid system rather than using the federal template, which means the program rules, income limits, and covered services are specific to Oregon.

OHP covers doctor visits, hospital care, prescription drugs, mental health services, and dental care for adults and children who meet income requirements. The program is free or very low-cost depending on your household income. Oregon residents who cannot afford private insurance often use OHP as their main health coverage.

Because OHP is state-run, the rules and what it covers can differ from Medicaid in other states. If you move to Oregon or are new to the state, you will need to understand Oregon's specific program rather than assuming it works like Medicaid where you came from.

Key Takeaways

  • OHP is Oregon's Medicaid program and covers medical, dental, mental health, and prescription drug services for low-income residents.
  • Income limits and covered services differ from Medicaid in other states because Oregon runs its own program.
  • You can learn about OHP income limits and what services are covered by contacting the Oregon Health Authority or visiting their website.
  • OHP is administered through managed care plans, meaning you choose or are assigned to a health plan that coordinates your care.
  • Oregon residents can check their OHP status and manage their account through the Oregon Health Authority's online portal.

How OHP differs from standard Medicaid

Oregon has shaped its Medicaid program differently than many other states. The state uses a managed care model, meaning OHP members are enrolled in health plans that coordinate their care rather than paying providers directly. This structure affects how you find doctors, get referrals, and access specialists.

Oregon also sets its own income thresholds for who can enroll in OHP. These limits change based on family size and are updated annually. Because Oregon's economy and cost of living differ from other states, the income cutoffs may be higher or lower than what you would see in neighboring states.

The services covered by OHP — such as dental work, vision care, and mental health treatment — are also determined by Oregon, not by federal Medicaid rules alone. Some services that are optional under federal Medicaid, Oregon includes in OHP. Others may have different limits or requirements.

Who can enroll in OHP

OHP is open to Oregon residents whose household income falls below the state's limits. Income thresholds vary by family size and change each year. You must also be a U.S. citizen or may have access to immigrant to enroll.

OHP covers children, pregnant people, parents and caretakers, people over 65, and people with disabilities. Oregon also expanded OHP to cover adults without children up to a certain income level, which is broader than some other states' Medicaid programs.

To find out whether your household income qualifies, you will need to contact the Oregon Health Authority or use their online screening tool. Income limits are specific to Oregon and change annually, so checking directly is the only way to know your status.

How to learn more about OHP coverage and services

The Oregon Health Authority is the state agency that runs OHP. Their website contains information about income limits, covered services, how to enroll, and how to manage your account if you are already enrolled.

You can also call the Oregon Health Authority directly to ask questions about what OHP covers, whether you meet the income requirements, or how to enroll. They can walk you through the process and answer questions specific to your situation.

If you are already enrolled in OHP, your health plan's member services team can tell you which doctors are in your plan, what your copays are, and how to get referrals or prior authorization for services.

OHP and managed care plans

When you enroll in OHP, you are assigned to or choose a managed care plan. This plan is responsible for coordinating your health care — finding you a primary care doctor, managing referrals to specialists, and handling billing. You do not pay the plan directly; OHP does.

Each managed care plan has its own network of doctors, hospitals, and pharmacies. If you have a preferred doctor, you should check whether they are in your plan's network before enrolling or switching plans. Using an out-of-network provider usually costs more or is not covered.

You can change your OHP managed care plan during open enrollment periods or if you have a may have access to life change, such as moving to a new county. The Oregon Health Authority can tell you when enrollment periods occur and which plans serve your area.

What OHP covers

OHP covers a broad range of health services, including preventive care, doctor visits, hospital stays, emergency care, prescription medications, mental health and substance use treatment, dental care, and vision services. Maternity and newborn care are also covered.

Some services may require prior authorization, meaning your doctor or plan must get approval before you receive the service. Others may have copays or limits on how many visits you can have per year. Your health plan can tell you the specific rules for any service you need.

Covered services and copays can change from year to year. If you are enrolled in OHP, your plan will send you information about any changes to your coverage at the start of each year.

Keeping your OHP coverage active

OHP enrollment is not permanent. You must renew your coverage periodically, usually once per year. The Oregon Health Authority will send you a notice when it is time to renew and will tell you what information you need to provide.

Your coverage can end if your income rises above the program's limit, if you move out of Oregon, or if you fail to renew when asked. If your coverage ends, you can reapply if your circumstances change and you meet the income requirements again.

If you have a major life change — such as losing a job, having a baby, or getting married — you may be able to renew or change your coverage outside the regular enrollment period. Contact the Oregon Health Authority to ask about your options.

Frequently Asked Questions

Is OHP the same as Medicaid?

OHP is Oregon's version of Medicaid. It is a state-run program that follows federal Medicaid rules but has Oregon-specific income limits, covered services, and enrollment rules. If you move to another state, that state's Medicaid program will have different rules and coverage.

What is the income limit for OHP?

OHP income limits vary by family size and change each year. The Oregon Health Authority publishes current limits on their website and can tell you whether your household income qualifies. You will need to provide proof of income when you apply.

Can I choose my doctor in OHP?

You can choose a doctor from your health plan's network. If your preferred doctor is not in the network, you may be able to request an exception or switch to a different OHP plan that includes them. Your plan's member services team can help you find in-network doctors.

Do I have to pay copays with OHP?

OHP copays depend on your income level and the service. Some preventive services have no copay. Other services may have small copays, usually a few dollars. Your health plan will tell you the copay for any service before you receive it.

What happens to my OHP if I move out of Oregon?

Your OHP coverage will end when you move out of state. You will need to apply for Medicaid in your new state if you still meet that state's income requirements. Contact the Oregon Health Authority to end your coverage and ask about the process in your new state.