Oregon Health Plan (OHP / Medicaid) members are now able to get Opill birth control pills and emergency contraception without a prescription and at no cost at covered pharmacies in the state. Oregon Health Authority (OHA), in collaboration with the Oregon Board of Pharmacy, made this possible through a standing order, which allows pharmacists to provide these medications to OHP members and bill OHP.
In Oregon, these medications are already covered without a prescription for people with private insurance. Federal law, however, requires that all medications for Medicaid enrollees be prescribed by a licensed practitioner who is enrolled in the state’s Medicaid program. Oregon’s new standing order means that OHP members will no longer have to get a prescription to access these contraceptives at no cost.
How OHP members can get access:
- OHP members can go to their approved pharmacy and request emergency contraception or Opill, and for it to be covered by OHP.
- Most OHP members get their benefits through a local coordinated care organization (CCO); OHP members can call their CCO and ask which pharmacy to go to.
- OHP members not in a CCO (known as OHP Open Card), or who do not know which CCO they’re in, can call OHP Client Services for help at 800-273-0557.
- OHP members will need to provide their OHP ID number, which is on their OHP ID card or CCO ID card, or by providing personal information that enables the pharmacy staff to search for and confirm enrollment in OHP.
Where to find out more:
Traditional Health Worker (THW) Culturally and Linguistically Specific (CLS) application now available
The CLS application for THWs is now available! It is in the “How to Apply” section of OHA's CLS web page. Please see the links below:
OHA seeks doulas for new committee to inform THW postpartum doula certification
OHA is forming a committee to inform how OHA:
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Develops Oregon Administrative Rules (OARs) about THW certification of postpartum doulas, and
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Defines THW scope of practice and qualifications for postpartum doulas.
OHA expects members to have experience and expertise related to Medicaid, THWs and postpartum doulas.
OHA is seeking committee members who:
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Work or have worked as a postpartum doula
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Serve urban families as a doula
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Represent a community-based doula organization or doula hub
OHA is also seeking members from:
CCBHC Certification Orientation: New quarterly webinar
OHA is hosting quarterly CCBHC Certification Orientation sessions for providers interested in applying for CCBHC Certification. Attending this session is required for all clinics seeking to apply for CCBHC certification.
OHA's first orientation session will be Jan. 12, 2026, from 2:05 to 4 p.m. Pacific Time. The webinar will cover:
- Brief overview of program requirements
- CCBHC certification process and requirements
- Question and answer time
CCBHC Cost Report Training: Jan. 15, 2026, 12:35 to 2 p.m. Pacific Time
This training is required for providers applying for CCBHC certification. OHA also offers this training to current CCBHCs seeking additional training and support for CCBHC Cost Reporting.
This webinar will introduce and walk through the CCBHC cost report. This report is a critical requirement for establishing and maintaining each CCBHC's bundled daily rate with OHA.
Increasing Language Access in Oregon: A Workbook for Providers is designed to help health care organizations, providers and care teams understand Oregon's language access requirements and take practical steps to ensure patients receive care they understand. It highlights strategies to:
- Meet federal and state standards,
- Improve performance on the Meaningful Language Access (Health Equity) measure, and
- Strengthen trust and communication with patients who communicate in a language other than English or who use sign language.
This workbook was developed by NORC at the University of Chicago in collaboration with the Oregon Health Authority. It was launched during a one-hour webinar on December 9. The slides and recording will be posted soon to the language access technical assistance webpage.
Questions? Email Questions.LanguageAccess@oha.oregon.gov.
Behavioral Health Directed Payments webinar material now available
On Dec. 5, 2025, more than 300 participants came together for the 2026 Behavioral Health Directed Payment Webinar, which was a reflection of the deep concern, urgency, and commitment across our system to address the growing cost pressures in behavioral health care for Medicaid members.
We want to extend our sincere thanks to all who joined us. Your voices and perspectives are essential as we navigate a time of significant change and strain.
We encourage you to review and share these materials with your teams.
Processing options for non-pharmacy fee-for-service prior authorization requests
Effective Dec. 1, 2025, OHA no longer offers the "Immediate" processing option for non-pharmacy prior authorization (PA) review requests. This is because:
- OHA does not require PA for services rendered to treat emergent or immediate health needs.
- This change will align OHA's fee-for-service PA review process with managed care operations.
The MMIS Provider Portal will continue to offer the “Immediate” review option for pharmacy requests. If a non-pharmacy request is submitted as "Immediate," OHA will automatically change the priority to “Urgent” review.
Timeframes for "Urgent" and "Routine" processing options
Also as of December 1, the timeframes for non-pharmacy PA reviews reflect the CMS Interoperability Rule update taking effect Jan. 1, 2026. The revised PA review timeframe options are:
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Urgent requests are addressed within 3 calendar days (not 3 business days)
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Routine requests are addressed within 7 calendar days (not 14 calendar days)
Updated PA Request Form and EDMS Coversheet now available
OHA has updated the EDMS coversheet (MSC 3970) and Fee-for-Service PA Request Form (MSC 3971) with the effective date of Dec. 15, 2025. The forms are available on the OHP Forms page at OHP.Oregon.gov/Forms.
Please use the updated forms for all requests submitted on or after December 15.
PA Assignment Code updates
OHA has updated the following PA Assignment Codes in the provider portal. PAs using these codes will be updated to reflect the change.
- CHIRO is now CHIROPRACTIC
- DENTAL-MALOCCLUSION is now DENTAL-HM ORTHODONTIC
- HOSPITAL – INPATIENT is now HOSPITAL-INPATIENT
- HOSPITAL – OUTPATIENT is now HOSPITAL-OUTPATIENT
- HEARING HOSP is now AUDIO & HEARING AID-HOSP
- HEARING NOT HOSP is now AUDIO & HEARING AID-NOT HOSP
- LAB & XRAY is now IMAGING & LABS
- ORTHODONTIC SERVICES is now DENTAL-ANESTHESIA
- OT HOME HEALTH is now OT-HOME HEALTH
- OT HOSP is now OT-HOSP
- OT NOT HOSP is now OT-NOT HOSP
- PT HOME HEALTH is now PT-HOME HEALTH
- PT HOSP is now PT-HOSP
- PT NOT HOSP is now PT-NOT HOSP
- REHAB is now REHAB-INPATIENT
- SPEECH HOME HEALTH is now SPEECH-HOME HEALTH
- SPEECH HOSP is now SPEECH-HOSP
- SPEECH NOT HOSP is now SPEECH-NOT HOSP
Other codes remain unchanged.
Requesting reconsideration for denied PA requests
When OHA denies a fee-for-service PA request, the member gets a denial notice. This notice includes notice of fair hearing rights, which lets the member know what to do if they wish to dispute the denial.
If a requesting provider wishes to dispute the denial, they may submit a new PA request that:
- Includes all of the necessary supporting records and
- Addresses the reasons OHA denied the previous PA request.
Please do not attach additional information to the denied PA request.
2026 HRSN Service Provider Office Hours
OHA will continue to host office hours sessions for health-related social needs (HRSN) service providers throughout 2026. The next office hours session will be on Wednesday, Jan. 14, 2026, from 8:30 to 10 a.m. Pacific Time.
These sessions are an opportunity for HRSN providers to ask OHA subject matter experts questions and get answers live.
If you need support or accommodations to participate, please email HRSN.Program@oha.oregon.gov.
Questions? If you have questions related to HRSN services, please visit our HRSN webpage or contact HRSN.Program@oha.oregon.gov.
Recent rule revisions
OARs 410-149-0100, 410-149-0110, 410-149-0120, 410-149-0130, 410-149-0140, 410-149-0150: Repeals the rules for the Comprehensive Primary Care Plus demonstration for Fee-For-Service OHP clients. No public comment was received
OARs 410-120-1160 and 410-120-1210: Extends the post-hospital extended care benefit from 20 to 100 days. No public comment was received.
OARs 410-120-1295, 410-125-0141, 410-125-0195: Rescinds 7/1/2025 wage index rule changes, restoring the rules to their prior state before that effective date. Reinstating out of state wage index for inpatient and outpatient hospital rate development. No public comment was received.
Division 122: Amended to update several Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) rules.
Provider resources
Oregon Unique DRG Weight Table, effective 10/1/2025
High-Cost Drug Carve-Out List, effective 1/1/2026
State of Oregon Standing Order to Provide Over-the-Counter (OTC) Oral Hormonal Contraception and Emergency Oral Hormonal Contraception to Oregon Health Plan (OHP) Members, effective 12/16/2026
Member Fact Sheet: Opill and Emergency Contraception (English)
Member Fact Sheet: Opill and Emergency Contraception (Spanish)
Social Media Card: OHP members can get Opill and OTC emergency contraception without a prescription at no cost (PNG)
Social Media Card: How to Get Opill or OTC emergency contraception (PNG)
Approved Culturally and Linguistically Specific Providers (12/12/2025)
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