Oregon Medicaid, known as the Oregon Health Plan (OHP), provides health coverage for low-income residents across the state.
In 2025, eligibility is based on the updated Federal Poverty Level (FPL), with broad access for adults, children, pregnant women, and people with disabilities.
Oregon is an expansion state, meaning more residents can qualify compared to non-expansion states.
Key Takeaways
- Oregon Medicaid operates as the Oregon Health Plan (OHP).
- Adults qualify up to 138% FPL under expansion.
- Children and pregnant women qualify at higher thresholds.
- Oregon provides extra benefits like dental and behavioral health care.
Oregon Medicaid in Context
Oregon has been a leader in expanding Medicaid access. Through the Oregon Health Plan, nearly 1.4 million residents are enrolled, representing over one in three Oregonians. The state prioritizes not just medical coverage but also preventive and mental health care.
Unlike many states, Oregon Medicaid includes comprehensive dental services, which are not typically part of standard Medicaid coverage. It also integrates behavioral health and addiction treatment, ensuring broader care for vulnerable populations. This makes OHP one of the most inclusive Medicaid systems in the U.S.
Another unique feature is the use of Coordinated Care Organizations (CCOs). These regional networks manage care for Medicaid members, helping to control costs while improving health outcomes. CCOs connect patients with both health providers and community services, making OHP more than just an insurance program.
Income Limits by Household Size (2025)
| Household Size | 100% FPL (Annual) | 138% FPL (Adults) | 200%+ FPL (Pregnancy/Children) |
| 1 person | $15,650 | $21,597 | ~$31,300+ |
| 2 person | $21,150 | $29,187 | ~$42,300+ |
| 3 person | $26,650 | $36,777 | ~$53,300+ |
| 4 person | $32,150 | $44,367 | ~$64,300+ |
Source: HHS Poverty Guidelines 2025
For example, a single adult making less than $21,600 per year can qualify for OHP, while a pregnant woman in a family of four could qualify with a household income of up to about $64,000 or more.
Who Qualifies for Oregon Medicaid?
Adults 19–64
Covered up to 138% FPL under Medicaid expansion. This includes adults without children, which is not the case in many non-expansion states.
Children
Children qualify at higher income thresholds, often up to 200% FPL, ensuring widespread pediatric coverage.
Pregnant Women
Pregnant women qualify at expanded income levels, with extended postpartum coverage to ensure maternal health.
Seniors and People with Disabilities
Older adults and disabled Oregonians may qualify for Medicaid with income and asset tests. Many also access long-term care waivers, allowing them to remain at home instead of moving into nursing facilities.
How to Apply for Medicaid in Oregon (2025)
- Apply online at the Oregon Health Plan portal.
- Use the screening tool to estimate eligibility.
- Prepare documents:
- Proof of income (pay stubs, W-2s, or tax return)
- Proof of residency (lease, utility bill, Oregon ID)
- Social Security numbers for household members
- Immigration status documents, if applicable
- Submit your application online, by mail, or with local assistance.
- Members who want to renew yearly must update their information annually.
Alternatives if You Don’t Qualify
For residents who earn slightly too much for Medicaid:
- CHIP (Children’s Health Insurance Program): Provides low-cost coverage for children above Medicaid limits.
- Marketplace Plans: Oregon residents can purchase subsidized coverage through HealthCare.gov.
- Community Health Centers: Offer reduced-cost care based on income.
- State Waiver Programs: Provide support for seniors or disabled residents needing long-term care.
FAQs
Q1: What is the income limit for adults under OHP in 2025?
Adults qualify up to 138% of FPL, about $21,600 per year for a single adult.
Q2: What benefits does Oregon Medicaid cover beyond medical care?
OHP includes dental, vision, behavioral health, and addiction treatment, making it more comprehensive than most states.
Q3: Can children qualify even if parents don’t?
Yes, children qualify at higher thresholds, often up to 200% FPL.
Q4: What are Coordinated Care Organizations (CCOs)?
They are regional networks that manage Medicaid care in Oregon, connecting patients to health and community services.
Q5: Do pregnant women qualify at higher levels?
Yes, pregnant women qualify up to ~200% FPL, with extended postpartum care.
Q6: How do I apply for OHP?
Through the Oregon Health Plan portal at one.oregon.gov.
Conclusion
Oregon Medicaid, through the Oregon Health Plan, stands out for its inclusive coverage and expanded benefits. Adults qualify up to 138% FPL, while children and pregnant women are supported at higher thresholds. The program also integrates dental, vision, and behavioral health, setting it apart from most states.
If you think you qualify, apply online through the Oregon Health Plan portal. For those above the limits, CHIP, marketplace subsidies, and state waiver programs remain vital alternatives.
