What Is the Oregon Health Plan (OHP)?
The Oregon Health Plan (OHP) is a program that pays for health care for low-income Oregonians. The State of Oregon and the U.S. Government’s Medicaid program pay for it.
The Oregon Health Plan (OHP) is a program that pays for health care for low-income Oregonians. The State of Oregon and the U.S. Government’s Medicaid program pay for it.
PacificSource Community Solutions is a Coordinated Care Organization (CCO). We are a group of all types of health care providers. We work together on behalf of people in our community who are on OHP. With a CCO, you can get all of your health care services from the same plan.
These are examples of services that may be covered. Some benefits are limited depending on your age and if you are pregnant:
For more information, look at your member handbook or give us a call.
The following services are examples of things that are not covered:
You may have to pay for services that are covered by us if you see a provider that does not take OHP or is not part of our provider network. Before you get medical care or go to a pharmacy, make sure that they are in our network.
You can search for a provider or a pharmacy here.
You will have to pay for services if you were not eligible for OHP when you received the service. The date you became eligible for OHP is on your OHP coverage letter from DMAP. You will have to pay for services not covered by OHP if you sign a detailed Agreement to Pay (a waiver) for that specific service before you receive it.
Even if your service is covered by OHP, you may have to pay a copay. You can’t be denied services if you can’t make your copay, but you will still owe the money to your provider.
Give us a call. We are happy to help you find a new PCP. You can change your PCP up to two times per year. You can also download the PCP change form, fill it out and return it to us.
If you think you need to see a specialist or other provider, make an appointment with your PCP first. Your PCP will decide what services and tests you may need.
Take your PacificSource ID card to all of your healthcare appointments. Also take it to the pharmacy when you fill a prescription. Keep your OHP ID card in a safe place at home.
Call the dental plan listed on your PacificSource Member ID card.
As soon as you know you are pregnant, call your DHS caseworker. Your caseworker will make sure you don’t lose medical coverage before your baby is born. If you don’t have a caseworker, call OHP at (800) 699-9075.
Care while you are pregnant is very important. Call your PCP to make an appointment for prenatal care. Or, if you’d like, you can select your own obstetrician or prenatal care provider from our Provider Directory.
You will need to call OHP Customer Service or your caseworker if your pregnancy ends.
Don’t pay the bill. Call us right away so we can help.
Tell your caseworker as soon as possible. If you don’t have a caseworker, call OHP Customer Service at (800) 699-9075.
PacificSource has a list of covered drugs called a formulary. Pharmacists and doctors decide which drugs should be on the list. Some drugs have additional requirements or limits on coverage.
If you have questions about the list of drugs, or you want us to mail you a copy, give us a call.
You can also find the list online at www.CommunitySolutions.PacificSource.com/Search/Drug.
Some people are eligible for both Medicare and Medicaid. They are called “dual eligible” members.
Medicaid (OHP) serves people of any age who have limited income and assets. Medicare serves people who fit at least one of the following descriptions, regardless of income:
If you are a PacificSource Community Solutions member and you have Medicare coverage, we can help you enroll in a PacificSource Medicare plan. Depending on your location, you may have the option to enroll in a Medicare Advantage with an affiliated carrier.
A PacificSource Medicare Advantage plan will cover your Medicare benefits and prescription drugs covered by Medicare.
Ask your doctor’s office if you need an interpreter. A certified interpreter is free. Healthcare Interpreter Service is available for all your healthcare appointments, including dental care and mental-health care. If you have questions, PacificSource Customer Service is happy to help.