Oregon Medicaid Eligibility and Enrollment

Oregon Medicaid is a government program designed to ensure that low-income residents have access to preventive care, diagnostic tests and treatment for a variety of health conditions. 

What Is Oregon Medicaid Called?

In Oregon, the state Medicaid program is known as the Oregon Health Plan. The program is unique because it was developed with a Medicaid waiver that allows states to create pilot programs or experimental programs designed to explore new methods of paying for health care.

Oregon used its waiver to create a health plan that doesn't cover some of the most expensive services, reducing government expenditures. Oregon was also one of the first states to incorporate managed care into its Medicaid program, further reducing the cost of providing health coverage to the state's low-income residents.

Oregon Medicaid Plans

Oregon Health plan has several benefit packages available to meet the needs of Oregon residents, including Oregon Health Plan Plus (OHP Plus), OHP with Limited Drug, Citizen Alien Waived Emergent Medical (CAWEM) Plus and Qualified Medicare Beneficiary (QMB).

Oregon Health Plan Plus

OHP Plus covers a wide variety of services for eligible beneficiaries. Some of these services, such as X-rays, laboratory tests, hospital care and care provided by a doctor, physician assistant or nurse practitioner, are considered "mandatory benefits" by the Centers for Medicare & Medicaid Services. OHP Plus also covers the following services:

• Treatment for chemical dependency
• Basic dental services, including cleanings, extractions, dentures and emergency dental care
• Hearing exams/hearing aids
• Medical supplies
• Durable medical equipment
• Glasses to correct vision problems caused by a qualifying medical condition
• Mental health care
• Hospice care
• Prescription medications
• Occupational therapy
• Physical therapy

OHP With Limited Drug

OHP With Limited Drug covers the same medical services as OHP Plus, but it only covers prescription medications that aren't covered by Medicare.

CAWEM

CAWEM only covers emergency medical treatment, which is defined as treatment for a condition that could be "reasonably expected" to result in serious impairment of bodily function, put the beneficiary's health in serious jeopardy or cause serious dysfunction of any organ or body part.

Qualified Medicare Beneficiary

The QMB program is designed for Medicare beneficiaries who need help paying their out-of-pocket costs. Therefore, QMB only covers Medicare deductibles, premiums and copayments for Medicare Part A and Part B.

Who Is Eligible for Medicaid in Oregon?

Oregon Medicaid is available to low-income residents of Oregon who are U.S. citizens, legal aliens, permanent residents or U.S. nationals. CAWEM is available to undocumented immigrants and lawful immigrants who aren't considered legal aliens, U.S. nationals or permanent residents. CAWEM applicants must meet all other eligibility requirements to qualify for coverage. QMB coverage is available to older adults who are already enrolled in Medicare and need help paying their out-of-pocket medical costs.

What Is the Income Limit for Medicaid in Oregon?

The income limit for Oregon Medicaid depends on an applicant's household size, as shown in the table below.

For households with more than eight members, an applicant can add $5,958 per person to determine the Medicaid income limit. A household with 10 people, for example, would have a limit of $70,596 per year ($58, 680 + $11,916 for two additional household members).

How Do I Enroll in Medicaid in Oregon?

• To apply online, visit the Oregon.gov website. Under "Apply for Benefits," click the Apply Now button to create an account and submit an application.
• Applicants who want to check their eligibility before filling out the Medicaid application should visit the state website and answer the screening questions.
• Call OHP Customer Service to request a paper application. The telephone number is (800) 699-9075. Applicants with hearing impairments can call 711 to use TTY.
• Obtain a paper application by visiting the Oregon Department of Human Services Mail the completed application to OHP Customer Service, P.O. Box 14015, Salem, OR 97309-5032. Fax the completed application to (503) 378-5628. Be sure to use the required fax cover sheet, which is included in the application packet on the Oregon DHS website.

Contact Information for Oregon Medicaid

Mail: OHP Customer Service, P.O. Box 14015, Salem, OR 97309-5032
Fax: (503) 378-5628
Telephone: (800) 699-9075
Web: Oregon Health Authority