OHP A. Program Intent and Overview

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OHP Program Manual

A. Program Intent and Overview

Effective 8/23/13

1. Program Intent

The intent of the Oregon Health Plan (OHP) is to ensure that low income Oregonians have access to medical care. OHP provides medical assistance to many individuals and families who might not otherwise have access to medical coverage.

For more information regarding benefit packages, click here and then click on OMAP Worker Guide. Scroll down to OMAP Worker Guide #4.

2. Program Overview

OHP is a cooperative effort by health care providers, health care consumers, insurers and lawmakers. Medical conditions paired with their recommended treatment are prioritized. The legislature determines what services can be paid for and sets the cutoff point on the list (click here to view the prioritized list).

People eligible for OHP will receive either the OHP Plus benefit package, a comprehensive medical plan, or the OHP Standard benefit package, a benefit plan similar to private health insurance. The eligibility for a specific program determines which benefit package a person will receive. Individuals eligible for OHP-OPU receive the OHP Standard benefit package. Individuals eligible for all other OHP programs receive the OHP Plus benefit package.

Only OHP-OPU clients receive the Standard benefit package. All other OHP clients receive the Plus benefit package. Other medical programs receiving the Plus benefit package are: OSIPM, BCCM, REFM and all other OHP categories. When determining eligibility for medical, consider first those programs that would provide the highest level of benefits. For example, consider OSIPM eligibility before OHP-OPU because OSIPM provide the Plus benefit package.

Note: For more information regarding benefit packages, go to the DMAP Medical Workers and then click on OMAP Worker Guide. Scroll down to Worker Guide #4.

The program includes five categories of people who may qualify for benefits. The categories are:

Oregon Health Plan for Nonpregnant Adults; OHP-OPU. This category consists of uninsured adults who may qualify for medical assistance under the OHP-OPU (100%) income standard. A person eligible under OHP-OPU is sometimes referred to as a health plan new/noncategorical (HPN) client. Effective July 1, 2004, OHP-OPU is closed to new applicants. To be eligible for this program, an applicant must either be recertifying or transitioning from another Medicaid program without a break in assistance.
Oregon Health Plan for Children; OHP-OPC. This category consists of children who may qualify for medical assistance under the OHP-OPC (100%) income standard.
Oregon Health Plan for Children; OHP-OP6. This category consists of children under the age of 6 who may qualify for medical assistance under the OHP-OP6 (133%) income standard.
Oregon Health Plan for Pregnant Females and Newborn Children; OHP-OPP. This category consists of pregnant females who may qualify for medical assistance under the OHP-OPP (185%) income standard and their newborn children.
Oregon Health Plan for Persons under 19; OHP-CHP. This category consists of uninsured persons under the age of 19 who may qualify for medical assistance under the OHP-CHP (301%) income standard. This program is authorized by the Children’s Health Insurance Program (CHIP) provision of the Federal Balanced Budget Act of 1997 and is not a Title XIX (Medicaid) program.

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