MedicaidCoverageMedium impact
Young Adults with Special Health Care Needs eligibility changes effective Jan. 1, 2026
Oregon Health Plan·OR · Pediatrics, Family Medicine·Provider
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Oregon's Young Adults with Special Health Care Needs (YSHCN) program expanded eligibility to include young adults through age 21, effective January 1, 2026. This allows eligible young adults to maintain comprehensive EPSDT coverage as they transition to adulthood. The policy applies to Oregon Health Plan providers serving this population.
Action Required
Immediately: Verify eligibility for young adults ages 18-21 with special health care needs for YSHCN benefits when serving Oregon Health Plan members. Update patient eligibility verification procedures to check for YSHCN coverage. For fee-for-service billing questions, contact Provider Services at dmap.providerservices@oha.oregon.gov or 800-336-6016. For CCO members, contact the member's specific CCO for billing guidance.