Investor Presentaiton
economy. Due to the size and dollar amounts flowing into this program, it is important the state take
steps to ensure the program is run efficiently and effectively to better serve people in Oregon.
Figure 5: In most Oregon counties, one-in-three people received Medicaid benefits in 2022
37%
29%
34%
24%
36%
36%
31%
40%
38%
43%
31%
36%
32%
24%
40%
31%
39%
40%
34%
39%
53%
25%
36%
34%
42%
43%
39%
35%
29%
41%
47%
40%
40%
48%
Source: OHSU's Office of Rural Health
51%
44%
The Oregon Health Authority administers Medicaid in Oregon
Oregon's Medicaid program, also known as the Oregon Health Plan, is administered by the Oregon
Health Authority (OHA). 5 OHA's 2021-23 biennial budget is over $32 billion with 5,100 full-time
employees across seven divisions. OHA works closely with other state and local agencies, as well as
Tribal governments, to provide services and health care to people in Oregon.
Medicaid is the largest program under OHA and accounts for 68% of the agency's budget. OHA's Health
Systems Division oversees the Medicaid program and sets guidelines regarding eligibility and services in
accordance with federal requirements.
The Oregon Department of Human Services also oversees some Medicaid-funded programs that
provide care to clients in their own homes or communities. These programs serve eligible, low-income
individuals. Although the department operates some pieces of Medicaid, ultimate state responsibility
for the program falls to OHA.
Six PBMs provide pharmacy benefits for all 16 of Oregon's Coordinated Care
Organizations
Oregon uses both fee-for-service (FFS) and coordinated care models to deliver services. The FFS
model is the more straightforward of the two: a Medicaid client visits a health care provider, the
5
Oregon Health Plan coverage also includes the Children's Health Insurance Program, Reproductive Health Equity Act, Cover All
Kids, and the Cover All People programs.
Oregon Secretary of State Report 2023-25 | August 2023 | page 6View entire presentation