HR1: Changes to your OHP coverage

Beginning in 2027, OHP members ages 19 to 64 may need to show that they meet new federal work or activity requirements to keep their health coverage.

Depending on your situation, you may meet the requirement by:

• Earning more than $580 per month of household income
• Working
• Volunteering
• Going to school at least half-time or in a training program
• Providing care for a family member or another person
• A combination of work, volunteer, education or training programs that add up to 80 hours a month
• Or qualifying for an approved exemption

If OHP needs additional information from you, they will send a letter explaining what you need to do next and what action to take. Make sure your contact information is up to date, open and read all mail from OHP and watch for updates about your coverage. 

Based on current guidance, work, volunteering, school, training programs and caregiving may count. Being enrolled in school at least half time or having household monthly income over $580 may also meet the rules. OHP will share more details when they are available.

People renewing coverage for April 1, 2027, are expected to get notices in early January 2027. The notices will ask for a response by early March. Coverage may end March 31 if a member does not respond. Follow the instructions and deadline in your notice.

An exemption means you do not have to meet the new work or activity requirements to keep your coverage.

Based on what we know so far, exemptions may include:

• People with disabilities, including
  • Blindness or a physical, intellectual, or developmental disability that significantly impairs ability to perform activities of daily living.
  • Veterans with a total disability rating from veterans affairs
• Main caretakers of children under age 14
• People with certain medical conditions
• People who have chronic substance use disorders or are currently in treatment
• People who are pregnant, and for one year after the pregnancy ends
• People who are American Indian/Alaska Native
• Adults age 65 and older
• People who were incarcerated in the last three months
• Former foster youth who are under the age of 26
• People taking care of someone of any age who has a disability
  
• People who meet Temporary Assistance for Needy Families (TANF) work rules
• People getting Supplemental Nutrition Assistance Program (SNAP) who SNAP 
• People who are entitled to Medicare Part A or B 

There will also be temporary exemptions for:

• Being admitted to stay overnight as a patient in a hospital or nursing facility
• Spending at least one week away from home to get medical care for yourself or a household member
• A declared emergency or disaster in a person’s county
• When there is a high unemployment rate in a person’s county

The state is still developing additional exemptions and will share more information as it becomes available. OHP will post updates at OHP.Oregon.gov/HR1.

An exemption applies to people who were in foster care at age 18 and are now younger than 26. OHP will share more information about this and other exemptions when it is available.

HR1 changes how some members qualify for and keep their health coverage. Some adults may need to meet new work or activity requirements to keep their coverage. This may include working, volunteering, going to school, providing caregiving, earning more than $580 per month of household income or qualifying for an exemption. An exemption means the work or activity requirements do not apply to you because of your circumstances.

Not everyone will be required to provide information. An automated verification process will be used whenever possible. If your information can't be verified through that process, OHP will send you a letter with instructions on any next steps.

If you do not respond to requests for information or do not meet the requirements, you could lose your eligibility for OHP coverage.

Oregon Health Plan (OHP) and/or ONE Customer Service Center will mail letters to explain what you need to do to keep your coverage. In addition to mailed notices, members who have opted in will receive updates by email or text message.

• OHP expects to mail notices in early January 2027 to members whose coverage renews on April 1, 2027.
• For some members, those notices could ask for a response by early March 2027.
• Coverage could end on March 31, 2027 if a member does not respond.

Be sure to respond to any requests for information and submit any required forms by the deadlines listed in your notices. Responding can help you avoid delays or interruptions in your coverage.

For now, there is nothing you need to do about your eligibility. However, it is important to plan ahead:

• Make sure your contact information is current at benefits.oregon.gov
• Open and read all mail from Oregon Health Plan and/or the ONE Customer Service Center
• Watch for updates about your coverage and renewal requirements
• For questions about HR1, call Oregon Health Plan Customer Service at 800-699-9075  
• Find an OHP assister who can help at oregonhealthcare.gov/gethelp   
• You can also follow updates at OHP.Oregon.gov/HR1  

Taking these steps now can help members avoid delays or interruptions in their coverage later.

Individual eligibility may vary based on new requirements. Different members of your family might receive different letters explaining changes to their individual eligibility. Keep an eye out for and open all mail that comes from Oregon Health Plan and/or ONE Customer Service Center.

Starting January 1, 2027, Medicaid's retroactive coverage period will be shorter. Retroactive coverage helps pay for eligible health care services you received before you applied for Medicaid.

Under the new rules:

• Adults without dependent children may be eligible for retroactive coverage for up to one month before their application date.
• All other eligible individuals, including children and adults with dependent children, may be eligible for retroactive coverage for up to two months before their application date.

OHP Bridge is largely unaffected by HR1 changes, including copays. OHP will let OHP Bridge members know if anything changes for them.

Starting October 2026, some immigrants, refugees, asylees, survivors of domestic violence and survivors of human trafficking will move to Healthier Oregon. Healthier Oregon is an OHP program.

OHP will share more details with members who are affected.

Members who have OHP through Healthier Oregon will move to OHP Open Card on January 1, 2027.

OHP Open Card is a type of OHP for members who are not in a coordinated care organization (CCO). CCOs are a group of health care providers that care for OHP members in their area. OHP Open Card has the same OHP benefits.

The health care providers you can see through OHP Open Card may differ. Ask your current health care providers if they accept OHP Open Card. If they do not, use the search tool at OHPopencard.org. After January 1, you can also call 800-562-4620 for help finding providers.

Starting in late 2027, many adults will have to renew their coverage every six months. Children and some other adults will have to renew every 12 months. OHP will let you know which applies to you.

Most members ages 19 to 64 in the *MAGI Adult, MAGI Adult - Healthier Oregon, or Young Adults with Special Health Care Needs programs will renew every six months. Adults in other OHP programs, including OHP Bridge, will renew every 12 months. 

*MAGI Adult is the main Oregon Health Plan (OHP) program for adults ages 19 to 64 who qualify based on their income and who do not qualify because of a disability, pregnancy, or another special eligibility category. Many of the new HR1 work and activity requirements are expected to apply to adults in this group.

OHP will send you details on what exactly you need to provide. Look for a letter with more information.