The Oregon Health Plan (OHP) covers wide range of possible medical services and it’s the best way for uninsured individuals and families with low-income to get a possibility to receive needed medical care. It covers services such as:

 

• Physician services

• Regular check-up, medical and dental check-ups as well,

• Diagnostic services,

• Maternity, prenatal and newborn care,

• Hospital stay,

• Prescription services,

• Dental services,

• Many mental health services.

 

There are also some other medical services which are considered as non-essential, so OHP won’t cover them. Those are “light illness” (conditions which don’t need special treatments, like colds), treatments that are not generally effective, weight loss programs, cosmetic surgeries or medical services aimed to cure fertility issues.

When you apply for OHP and after you’ve been approved, you’ll need to select a new medical and dental plan. You can select these from a list of providers based on different Oregon counties and the list could be found here: http://cms.oregon.gov/oha/healthplan/pages/managed-care/plans.aspx. Make sure you check those providers even before you apply for OHP coverage, since you will probably need to choose the right plan the first time you apply for OHP. Some counties even offer a chance to choose a Coordinated Care Organization (CCO). These organizations are local networks of physicians, mental health providers, hospitals and any other medical care providers. By joining into one network, they can work much more effectively and they will work together, which could result in much effective health care.

You need to know that if you don’t choose CCO or medical and dental plan while applying for OHP coverage, you might be enrolled automatically, based on the several criteria. In order to provide your family with the best possible medical care, it’s highly recommended to do a research on your own prior to applying for OHP. This way you’ll know which health care provider you are going to use.

There are always some helpful tips on how to find the best Coordinated Care Organization or medical and dental provider. You should ask the doctor you are seeing at the moment if that clinic is a provider of OHP covered medical care. It’s the best to continue seeing the doctor you already trust and besides that, he/she is already familiar with your medical history. If you don’t have a regular doctor at the moment, you can visit http://cms.oregon.gov/OHA/healthplan/pages/index.aspx, where you can find a list of providers. Make sure you call the provider you choose since it’s good to know all the rules for going to a specialist.

 

There are also some cases when you don’t need to choose a medical or a dental plan, and those cases are:

 

• If you have surgery scheduled. In this case you’ll be asked to choose an OHP plan after the surgery.

• If you have dental surgery scheduled.

• If you are pregnant and haven’t been enrolled in OHP during the last 6 months.

• If you have your own private or employer-sponsored health insurance.

• If you are applying for employer-sponsored insurance, for which the state pays coverage through your employer.

 

Since OHP is intended for low-income families, it is completely free in the most cases. Sometimes, if your income is slight over the income limit for OHP coverage, you will need to pay monthly premiums or co-payments each time you go to see a physician. These amounts are based on your gross income and your family size. There are also some social categories which are excerpt from paying premiums and those are:

 

• Pregnant woman,

• Persons under the age of 19,

• Families who qualify for Temporary Assistance for Needy Families program (TANF),

• Individuals who already use Social Security Income (SSI),

• Senior citizens (age of 65 and up),

• Very low-income families (income is below 10% of the Federal Poverty Level).

 

After you’ve been accepted to enroll with OHP program, you’ll get your new health insurance cards which you’ll need to show each time you need medical care. It’s strictly forbidden to use someone else’s card or to lend your card to someone else. This action leads to termination of your OHP health insurance coverage. There are also some other rules that you’ll need to follow. You will need to report any of the changes within your household or your income within the 10 days of that event. This means that you’ll need to report if you change your address, new pregnancies and births, deaths, injuries or accidents for which you needed to receive medical attention. In order to report these events, call OHP Central Processing Center at 1-800-699-9075, Monday to Friday, from 7am to 6pm.

Eligibility Requirements

This program is created for very low- and low-income families with income under the Federal Poverty Level. In general, these are the eligibility requirements:

 

• You need to currently reside in Oregon,

• You need to be a U.S. citizen, or eligible non U.S. citizen (legal alien),

• Income for your household needs to be under the Federal Poverty Level,

• Pregnant woman with low-income and children under the age of 19 are also eligible (in case they aren’t currently covered by any health insurance plan).

• There are also special cases when a person is currently in an abusive relationship and needs independence and medical help.

 

Different eligibility rules and income levels apply to different groups of people. This way, the level of coverage you can receive is based upon your current income, age, physical and mental condition.

Finally, you can find additional information regarding eligibility for OHP coverage in this PDF booklet: https://apps.state.or.us/Forms/Served/he9025.pdf.

Medicaid Application Instructions

There are several ways to apply for the Oregon Health Plan. You can apply online or print an application form so you can fill it out and send it to OHP Application Center.

 

• If you’d like to apply online, you can do that via Oregon Health Plan web application located here: https://apps.state.or.us/mbs/. This is a very intuitive online form that you can fill out in just a matter of minutes. You will also get all of the needed information about the additional document you’ll might need to gather.

• You can also print an application form and send it to OHP Processing Center (also known as OHP Application Center). You can download an application form from this website: http://cms.oregon.gov/oha/healthplan/Pages/app_benefits/main.aspx. Print it and fill it out, so you can mail it to take it by yourself in order for your application to be processed. If you’d like to send it by mail, the address is: OHP Processing Center, PO Box 14520, Salem OR 97309-5044. You can send it by fax (which is also convenient way if you need to send additional documents) using this fax number: 503-373-7493. Finally, you can turn in your application in person by finding out the location of your local branch office at www.oregon.gov/DHS/assistance/localoffices.shtml.

• You should be also able to find application forms at your local branch offices where you can also find additional help in case you have any questions or doubts.

• Finally, you can get OHP application form by mail. It will be sent to you by ordering it via 1-800-359-9517.

 

Besides having properly filled out application form, you will also need additional documents which are used as a proof of your financial status. This is necessary since this program is only intended for low-income families who are really in need of quality health care coverage.

These are the documents you’ll might need to gather:

 

• Proof that you’re a U.S. citizen or a proof of your immigration status,

• Proof of income,

• Information regarding your current health insurance, in care you’re using any.

• In case you’re pregnant, you’ll need a proof of pregnancy and due date signed by a medical provider.

 

Speaking of the proof of income, it can be your most recent paystub or a letter from your employer with the total amount that you will be paid this month. This letter needs to contain your employer’s contact information and need to be signed.

In case you’re self-employed, you’ll be obligated to send several documents which will show your business and financial activity for the current month (the month you are applying for OHP). These documents could be:

 

• Bookkeeping records,

• Contracts,

• Work agreements,

• Payroll records,

• Sales receipts,

• Most recent tax return, in case no other proof is available.

 

After you’ve applied, the process of reviewing your application can last for 45 days after which you should receive a definite answer. In case you’ve applied for OHP coverage for persons with disability, it might take up to 60 days to process your application. In case of any question regarding OHP application status, you can call OHP Statewide Medical Processing Center at 1-800-699-9075 (Monday to Friday, 7am to 6pm).