MedicaidCoverageMedium impact
Notice of intent: OHA will add clinical coverage criteria to the Medicaid State Plan.
Oregon Health Plan·OR · Dentistry·Public notice
Effective date
Jan 1, 2027
We identified it
Jun 20, 2026
Summary
Oregon Health Authority is transitioning away from its 1115 waiver to add clinical coverage criteria to the Medicaid State Plan, effective January 1, 2027. This change affects organ transplants, dental services, preventive services, physician services, and tribal health facilities, removing age limits for dental services and updating coverage language across multiple service categories.
Action Required
By June 26, 2026: Oregon Medicaid providers should review the proposed State Plan Amendment changes and submit comments to jesse.anderson@oha.oregon.gov if needed. By January 1, 2027: Update billing procedures to align with new clinical coverage criteria replacing the Prioritized List of Health Services. Remove age restrictions for dental services billing and ensure prior authorization processes align with updated medical necessity determination procedures.