Insurance Curator Oregon’s Medicaid program, the Oregon Health Plan or OHP, helps people get primary care, prescriptions, behavioral health, and more when they cannot afford private insurance. Eligibility depends on who you are, how many people live in your household, your income and assets, and your immigration status. This guide breaks down the rules in plain language so you can see where you fit and what to do next.
The big picture: who OHP serves
OHP covers several groups of Oregon residents:
- Children and teens in low and moderate income households.
- Adults under the Affordable Care Act expansion with low incomes.
- Pregnant people who need prenatal and postpartum care.
- Seniors and people with disabilities who meet income and asset limits.
- Some immigrants and people with specific legal statuses.
- People with urgent or emergency medical needs may be eligible for emergency-only coverage.
Each group has different rules. Below are the most important things to know.
Income cutoffs: MAGI vs non-MAGI groups
Oregon uses two different systems to check income.
- MAGI groups include adults, children, and pregnant people. MAGI stands for Modified Adjusted Gross Income and follows the federal rules used by the ACA.
- Non-MAGI groups include people who are elderly, blind, or disabled and those applying for long-term care. These rules look at income and assets differently.
Key points:
- Adults (Medicaid expansion): Adults without dependent children typically qualify if household income is at or below 138% of the Federal Poverty Level. That equals roughly $20,000 a year for one person and about $41,000 for a family of four, as of 2024. These numbers change annually with the Federal Poverty Level.
- Children: Oregon provides broader eligibility for kids, often allowing much higher income limits than adults. Check current thresholds when applying.
- Pregnant people: Pregnancy often raises the income limit compared to non-pregnant adults, and coverage continues through the postpartum period.
- Seniors and people with disabilities: These groups are assessed under non-MAGI rules that consider both income and countable assets. Asset limits can be strict for long-term care qualification.
If you want a deeper dive on how to apply and what happens after, see How to Apply for Oregon Medical Aid Online or With Local Assisters and What Happens After You Apply.
Immigration status and eligibility
Immigration status matters, but there are important exceptions and state options.
- Qualified immigrants such as lawful permanent residents usually face a five-year waiting period for federal Medicaid, but Oregon may offer state-funded programs or exceptions.
- Refugees, asylees, and certain humanitarian statuses are generally eligible for full OHP without a waiting period.
- Pregnant people and children may qualify faster or under state-funded rules even if they are not eligible for full federal Medicaid.
- Undocumented immigrants are not eligible for full OHP in most cases, but emergency services are typically covered, and some state or county programs can provide limited help.
Immigration rules are complex and can change. For more on this topic, read Understanding Oregon Medical Aid for Immigrants and Mixed Status Families: Rights and Options.
Special programs and targeted coverage
Oregon runs several special programs inside or alongside OHP that address particular needs.
- Behavioral health and addiction recovery programs provide counseling, therapy, and substance use treatment. Many services are covered under OHP, especially through Coordinated Care Organizations.
- Children’s services include school vaccines, wellness visits, mental health support, and developmental screenings.
- Reproductive health programs cover family planning, prenatal care, and postpartum services for eligible people.
- Pharmacy assistance and drug cost reduction programs help lower out-of-pocket costs for prescriptions.
- Local clinics and nonprofit programs help people navigate enrollment, renewals, and care options.
Explore programs in detail here:
- Using Oregon Medical Aid for Behavioral Health, Counseling, and Addiction Recovery Services
- Oregon Medical Aid for Kids and Teens: School Vaccines, Wellness Visits, and Mental Health Support
- Using Oregon Medical Aid for Reproductive Health: Family Planning, Prenatal Care, and Postpartum Services
- What Oregon Medical Aid Covers at the Pharmacy: Prescriptions, Refills, and Ways to Cut Drug Costs
Comparison table: Who qualifies and how income is measured
| Eligibility Group | Income test used | Typical cutoff or note |
|---|---|---|
| Adults under expansion | MAGI | Up to 138% FPL (about $20k for 1, $41k for 4 in 2024) |
| Children and teens | MAGI | Higher thresholds than adults; many qualify at several hundred percent of FPL |
| Pregnant people | MAGI | More generous limits; coverage continues postpartum |
| Seniors and disabled | Non-MAGI | Income and asset limits apply; long-term care has stricter rules |
| Refugees/asylees | Depends | Usually immediately eligible |
| Undocumented immigrants | N/A | Emergency care covered; limited state programs may assist |
Always check the current Federal Poverty Level and Oregon Health Authority rules because numbers and policies change each year.
Coordinated Care Organizations and keeping your doctor
Most OHP members join a Coordinated Care Organization, or CCO. CCOs manage care locally and coordinate medical, behavioral, and social services.
- You may be assigned to a CCO but can switch if your doctor is out of network.
- Changing CCOs usually will not interrupt your coverage if done correctly.
Learn how to change plans and avoid losing access at How to Change Oregon Medical Aid Coordinated Care Organizations Without Losing Your Doctor.
How to apply and get help
Applying can be done online, by phone, or with a local assister. You will need proof of identity, address, income, and immigration status if applicable. If you are unsure what documentation you have, local clinics and nonprofits can help you gather paperwork and complete the application.
Start your application and get help here: How to Apply for Oregon Medical Aid Online or With Local Assisters and What Happens After You Apply.
For free, in-person assistance, search for community partners and clinics near you in Oregon that specialize in enrollment. More resources are available at Local Clinics and Nonprofits Across Oregon That Help Residents Navigate Medical Aid and Affordable Care.
Final tips and next steps
- Check your eligibility every year because income and household size change.
- Keep documents handy so renewals go smoothly.
- Ask for help if you have complex immigration questions or need long-term care coverage.
If you want a focused walk-through on what happens after you enroll, or how OHP works for specific needs like mental health or pharmacy costs, explore these topics:
- Oregon Medical Aid 2026 Guide: How the Oregon Health Plan Supports Residents Who Need Care
- Using Oregon Medical Aid for Behavioral Health, Counseling, and Addiction Recovery Services
Oregon’s safety net is broad but rules can be detailed. If you think you might qualify, apply or contact a local assister today and get the care you need.