Oregon Health Plan Changes in 2027: Work Rules, Exemptions, and How to Keep Your Coverage
Oregon Health Plan Changes in 2027
Work Rules, Exemptions, and How to Keep Your Coverage
Last updated: 10/07/2026. These rules are still changing, and we'll update this post as Oregon shares more.
The rules for keeping the Oregon Health Plan (OHP), Oregon's Medicaid program, are changing over the next two years. Most people who have OHP now will keep it.
In other states that have already made changes like these, most people who lost coverage still qualified. They lost it because a letter went to an old address, a deadline passed, or a form didn't get sent back. That is the part you can do something about.
Starting January 1, 2027, some OHP members ages 19 to 64 will need to show one of three things each time they apply or renew: at least 80 hours a month of work, school, volunteering, or job training; more than $580 a month in household income; or an exemption.
Sprout client? [Read on to learn how we can help.]
What's changing for everyone with OHP
Who the new rules apply to
The work or activity rules apply to some adults ages 19 to 64. They don't apply to:
Children and teens under 19
Adults 65 and over
People who are pregnant
People with Medicare
People who get SSI or have OHP based on a disability
How to meet the rules
OHP checks when you apply and each time you renew. You meet the rules with any one of these:
Income: Your household earns more than $580 a month before taxes.
School: You're enrolled at least half-time, including high school or a GED program.
Hours: You do at least 80 hours a month of work, volunteering, caregiving, school, or job training, in any mix. Self-employment, seasonal work, and unpaid work count.
Volunteer hours need to be with a public agency or nonprofit that tracks your hours.
Exemptions
There is a long list of exemptions. You may not need to meet the rules if you:
Care for a child 13 or younger
Care for someone with a disability or serious health condition
Are getting care for a serious or disabling health condition that keeps you from working at least part-time, including some mental health conditions
Are in drug or alcohol treatment now, or were in the last 5 years
Are pregnant, or had OHP while pregnant in the last 12 months
Are American Indian or Alaska Native
Were in foster care when you turned 18 and are now 19 to 26
Were recently released from jail or prison
Recently stayed in a hospital or residential treatment
Are a veteran with a 100% disability rating
Get SNAP and have to meet SNAP's work rules, or get TANF and meet TANF's work rules
Getting SNAP is not enough by itself. If you're exempt from SNAP's work rules, you still need to meet OHP's rules or qualify another way.
OHP checks its own records first. In 2027, if they need more, you can tell OHP an exemption applies to you in your ONE account. No doctor's letter is needed in 2027. Starting in 2028, OHP will ask for proof of more exemptions.
See the full list in OHA's exemptions guide.
Other changes coming
More frequent renewals: Starting in late 2027, many adults ages 19 to 64 will renew every six months. Everyone else will renew once a year. Most people now renew every two years.
Less help with past bills: Starting January 2027, OHP will cover about one month of past medical bills for most adults 19 to 64, down from three. Children, people over 65, anyone pregnant, and people with OHP based on a disability get up to two months. A gap in coverage costs more than it used to.
Small fees in 2028: Starting October 2028, some adults will pay small fees for certain care. Mental health care, substance use treatment, checkups, emergency care, and prenatal care are not included.
If you are not a U.S. citizen
In Oregon, these changes do not mean losing OHP. Healthier Oregon gives full OHP benefits regardless of immigration status.
October 2026: Some adults, including refugees and asylees, move to Healthier Oregon. The benefits are the same.
January 2027: Healthier Oregon members move to OHP Open Card. The benefits are the same, but the providers you can see may change. Ask your care providers if they take Open Card.
If you're 19 to 21 and have had a health condition since childhood
An OHP program called Young Adults with Special Health Care Needs may cover you, with extra vision and dental benefits. The condition has to have started before you turned 19. The age limit is going up each year, so ask soon.
If you have OHP Bridge
Some of these changes may work differently for OHP Bridge. Call 800-699-9075 and ask how your coverage is affected.
Three things you can do right now
1. Make sure OHP has your current address, phone, and email
This is the most important one. If OHP can't reach you, you can lose coverage even if you still qualify.
Online: benefits.oregon.gov, or the free Oregon ONE Mobile app
Phone: 800-699-9075 (relay calls welcome)
In person: your local ODHS office
You can also ask for letters in your language, large print, or braille, at no charge.
2. Open and keep every letter you receive from OHP
OHP mailed notices in September 2026 to members the rules may apply to. You'll get another before your next renewal telling you what's needed and by when. Keep every letter, even if it looks like junk.
3. Know when your OHP renews
Check your ONE account, look at your most recent OHP letter, or call 800-699-9075 and ask. Write the date down.
If Your OHP Coverage Ends
Don't wait.
If you think it was a mistake, you may be able to appeal and keep your coverage while the appeal is decided. The deadline is short, about 10 days from the notice, so check your letter for the exact date. Appealing is often better than reapplying.
If you don't appeal, you generally have 90 days to respond and get coverage back without a new application. You can also reapply at any time.
Questions We're Hearing
Will I lose my OHP?
Probably not. Most people will continue to meet eligibility requirements needed to keep it. The main risk is missing a letter or a deadline.
Do I have to get a job to keep OHP?
Not necessarily. School, volunteering, caregiving, and job training count, and there are many exemptions. Start keeping paystubs, class schedules, and volunteer hours in one place now.
I have a mental health condition. Am I exempt?
You might be. The exemption is for people getting care for a serious or disabling condition that keeps them from working at least part-time. In 2027, you tell OHP it applies to you, with no doctor's letter. Only OHP decides.
Will I have to pay for therapy?
Not because of these changes. In October 2028, some services covered by Medicaid may require a copay - mental health care or substance use treatment are exempt and will continue to be covered in full.
If my coverage lapses, will my kids lose theirs?
Children's coverage is handled separately and doesn't automatically end when a parent's does. Call 800-699-9075 to check on your family's coverage.
Who to call
Qualifying, renewing, or reporting a change: 800-699-9075 or benefits.oregon.gov
Free hands-on help from a certified OHP assister: OregonHealthCare.gov/GetHelp
Using your benefits: your CCO, or 800-273-0557
If You’re A Sprout Client with OHP, We Can Help
Abby is our case manager. She can help you:
Find out when your OHP renews and keep track of it
Check that your contact information is current with OHP
Walk through how to report your situation to OHP
Understand a letter you got
Sort things out if your coverage stops
This is free and completely optional. It won't change your therapy in any way.
What Abby can't do: she can't apply or renew for you, and she can't tell you whether an exemption applies. Only OHP decides that. If you want hands-on help with an application, we can connect you to a certified OHP assister.
A few things to know
Telling Sprout isn't telling OHP. If you move or change your number, update us and update OHP.
Got a letter you don't understand? Bring it to your next session or send it through your client portal.
If your OHP stops, tell us right away. The sooner we know, the more options you have.
If you have Healthier Oregon, make sure to inform your team at Sprout that you will be moving to Open Card.
Wondering about a health exemption? Talk it through with your therapist.
How to get connected
Ask your therapist to connect you with Abby. You don't need a letter in hand or a problem to solve.
This is general information, not advice about your specific case. Only OHP can decide your eligibility. If something here doesn't match a letter you got, go by the letter and ask us about it.
Source: Oregon Health Authority, OHP Work or Activity Rules and Federal Changes to Oregon Health Plan.