The Oregon Health Plan (OHP) provides Oregonians access to health care.
OHP covers regular check-ups, prescriptions, mental health care, addiction treatment, and dental care. 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. There are also state subsidies to help parents who make too much money for the Oregon Health Plan to pay for private insurance.
Apply at www.oregonhealthcare.gov.
Care coordination help
If your child has OHP and requires a lot of providers, medications, or appointments, you may be eligible for some extra help coordinating that care from an Exceptional Needs Care Coordinator, Intensive Care Manager, or Community Health Worker. You can also ask for Family Peer Support Worker, who is a trained family member themselves and will understand what you are going through. See our tip sheet for instructions on how to request care coordination help.
Appeals and denials
Insurance sometimes does not cover what you think it should. There is help for you if you have difficulties with your provider or insurance company. First, call your insurance company's customer service line. Wait times can be long, but be persistent. You have a right to appeal the insurer's decision, and many families succeed in their appeals. Here is a form you can use to track conversations with your insurance provider. Below are some resources to help you understand the appeals process:
Oregon's Early Periodic Screening Diagnosis and Treatment is new to Oregon (2023) and is a mandate for OHP to cover "medically necessary treatments" for children and youth through age 20.
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.
Your OHP handbook will tell you everything you need to know about your plan. You can request a paper copy if you need one. 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.
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.