About OHP

About Oregon Health Plan/MEdicaid

What is the Oregon Health Plan (OHP)?

The Oregon Health Plan (OHP)/Medicaid provides health care coverage including medical, dental and mental health care, and substance abuse treatment for low-income adults and children living in Oregon.

Already a member? Click here.

There are several health care programs available for low-income Oregonians through OHP.

1. OHP Plus for children ages 0-18 and adults ages 19-64
2. OHP Plus Supplemental for pregnant adults age 21 or older
3. OHP with Limited Drug for adults who qualify for both Medicaid and Medicare Part D

To qualify for OHP, individuals and families must meet income and residency requirements. Residents of Oregon may also qualify based on age and disability status.

1. You MUST live in Oregon
2. You MUST meet the income bracket:


  • Adults (ages 19-64) In households that earn up to:
    • $1,436 a month for a single person
    • $1,945 for a family of two
    • $2,961 for a family of four
  • Children (0-18) In households that earn up to:
    • $4,298 a month for a family of two
    • $6,545 for a family of four
  • Pregnant women in households that earn up to:
    • $2,677 a month for a single pregnant woman
    • $4,077 for a family of four
    • $5,477 for a family of six

Other factors that also may influence OHP/Medicaid eligibility include other health care resources and disability status. The best way to see if you qualify is to apply.

Still not sure if OHP is right for you? Go to  OregonHealthCare.gov and answer the screening questions. This will help you find the application that works best for you and your family.


Resources:
OHP information
Guide to get setup for Oregon Health Plan
How to Apply Online




What is the applicant portal?

  • The applicant portal helps with:
    • Completing an application for health coverage
    • Selecting a Coordinated Care Organization (CCO) preference
    • Obtain contact information for community partners and application assistance
    • Report changes
    • Complete renewal


Need Help?

Trained community partners across the state can help you fill out an application. It's free. Visit OregonHealthCare.gov to find community partners in your area.

You can also learn more about how to fill out the application in the Application Guide.

What dental benefits are covered?

Here are some of the things that are covered. There may be a limit on how often you can have each one. Call your dental plan to learn more. If you do not know who your dental plan is, call your CCO or OHP Client Services.
  • Care to keep your teeth healthy
    • Cleaning and exam once a year
    • X-rays
    • Fluoride varnish (treatment that keeps teeth strong and healthy)
    • Sealants for children and youth under age 16 (coating on back teeth to prevent decay)
  • Treatment for problems
    • Fillings
    • Extractions (having a tooth pulled)
    • Dentures for youth over age 16 and adults
    • Stainless steel crowns for back teeth (other crowns for children and youth under age 21 and pregnant women)
    • Root canals on back teeth for children and youth under age 21
  • Emergency dental care
  • Help getting to dental appointments

How do I find a dentist?

If you have a coordinated care organization (CCO):

Most Oregon Health Plan members have a coordinated care organization (CCO). A CCO connects your insurance plan and your doctors so all your care works together. 

  • To find or change your dentist: Call your CCO. If you do not know which CCO you have, call Oregon Health Plan Client Services at 800.273.0557
  • Do you have a dentist you like? Call your CCO to see if there is a plan that works with your dentist

If you have fee-for-service OHP (FFS, also called Open Card)

If you do not know if you have a CCO or FFS:

(The Citizen Alien Waived Emergent Medical (CAWEM) program covers dental emergencies only. CAWEM Plus for pregnant women has full dental coverage. Please report your pregnancy to OHP to get CAWEM Plus.)

 

How do I make an appointment?

  • Call your dentist
    • Call early, it may take several weeks to get an appointment
  • If you will miss your appointment, call your dentist at least one day before. Be sure to reschedule
  • Do you need a free ride? Call your coordinated care organization (CCO) to learn how this works. Schedule the ride at least two days ahead

What if I have an emergency?

  • Call your dentist right away
  • If you do not have a dentist or cannot reach your dentist, call your coordinated care organization (CCO) or our 24hour emergency care line at 866.268.9631
  • If you have a true emergency (like bleeding that won’t stop) go to an emergency room

Learn more about dental emergencies.