During the COVID-19 public health emergency, rules about the Oregon Health Plan (OHP) changed. For those three years, most OHP members could keep their coverage even if their income went up or they qualified for Medicare.
As you may know, the public health emergency ended May 11, 2023. That means Oregon is returning to its previous policies for OHP, initiating a "redetermination" period. Redetermination is when the Oregon Health Authority (OHA) evaluates an OHP member’s
information to determine if they meet eligibility requirements to still qualify for OHP. (Please note: We are not using the word "redetermination" in member-facing materials, because this is an unfamiliar term for most members.)
A member cannot complete redetermination through CareOregon; they must do so through OHA. However, CareOregon will help support members through this process by answering questions, helping them update their contact information, and providing a warm handoff
to OHA.
Redetermination starting May 2023
- OHA will restart redetermination, and everyone who is currently covered by Medicaid will need to provide current information to OHA to evaluate if they still qualify for OHP coverage.
- Kids 0–5 only need to apply for Medicaid once and can stay on Medicaid until their 6th birthday.
- After the initial redetermination starting in May 2023, everyone over age 6 must reapply every two years (24 months). This redetermination will occur between May 2023 and January 2024.
For the most up-to-date information, please visit the OHA website. You can also see these resources:
- OHA Toolkit
- ONE Notices Guide
- Redetermination information for CareOregon providers and community partners
Below, find some answers to common questions.
What happens if someone is no longer eligible or does not submit the required documentation?
- If someone is over income for Medicaid (which varies by aid category), they will no longer be covered by Medicaid 60 days after they have been determined ineligible.
- Adults with income falling within the Federal Poverty Level (FPL) of 139%–200% may be eligible for the new Bridge and Basic Health Plans that OHA is developing. More information on this will come.
- Adults from 200%–400% FPL will be eligible for the Marketplace exchange.
- Children are eligible for Medicaid up to 300% FPL.
- There are other individuals who have different FPL requirements. They include those who are pregnant, living with disabilities or in foster care.
