Oregon Health Plan Basics
Eligibility
Your income will determine if you are eligible for OHP. Children with certain developmental disabilities, including Intellectual Disabilities and Autism Spectrum Disorder, may qualify regardless of income. Learn more about the Oregon Health Plan and how you can get help to apply www.oregonhealthcare.gov.
OHP coverage for members under age 21
OHP covers regular check-ups, prescriptions, mental health care, addiction treatment, and dental care. For children and youth under age 21 OHP covers all medically necessary and medically appropriate services and treatments. To understand your child's benefits read these important handouts.
Flexible services for Oregon Health Plan
The Oregon Health Plan may provide non-covered health related items and services for CCO members. Further information can be found in your member handbook. To apply talk to your child's healthcare provider, or contact your CCO. Pro tip: The process to apply for flex funds can take time. Plan ahead. Flexible Services for Oregon Health Plan
Care coordination help
If your child is enrolled in a Coordinated Care Organization (CCO) and requires a lot of providers, medications, or appointments, you can get help from a CCO care coordinator. Look in your CCO handbook for the number to call to request this help. New rules for OHP CCO care coordination and related definitions were published in 2024.
If your child has OHP but is not in a CCO you may still be eligible for help with care coordination. This free service is offered by Acentra Health.
Denials and appeals
Insurance, including the Oregon Health Plan, sometimes does not cover what you think it should. There is help for you if you have been denied a services you think your child needs. Your denial is not official until you receive a letter from the insurance company. For OHP members a "denial letter" is officially called a "Notice Adverse Benefit Determination". This letter will give you the steps to appeal. The appeals process takes time. Talk to your child's provider about what to do while you are waiting. If you need help understanding the appeal process call us.
If you have made an appeal but still can not get the care you need ask the OHA Ombudsperson Program
Here is a form you can use to track conversations with your insurance provider.
Patient Advocate Foundation: A Patient's Guide to Navigating the Insurance Appeals Process
Free medical transportation for OHP visits
Oregon offers free transportation for OHP members to approved medical appointments. In a metropolitan area, this might mean bus tickets or a taxi ride, but in much of Oregon, it means using one of the brokerage services.
OHP Handbooks
Your OHP handbook will tell you everything you need to know about your plan. You can request a paper copy if you need one, but all of them are also published on-line. On-line handbooks are searchable by topic. Your Coordinated Care Organization (CCO) also publishes a handbook. You should have one of each. If you need help finding your handbook on-line, contact the OR F2F HIC at 855-323-6744.
Disclaimer
Inclusion of resources on our site does not imply endorsement nor does exclusion mean we do not think it is valuable. We work to keep our list of resources current and relevant but it is not exhaustive.
If you have any questions call or email us tel. 855-323-6744 (English) o 833-990-9930 (español) contact@oregonfamilytofamily.org