Glossary

Oregon Health Authority - OHA

Oregon Health Authority (OHA) is the Oregon state level government authority on Oregon’s Medicaid program, Oregon Health Plan (OHP). OHA is the entity that negotiated with and ultimately got approval from federal partners for Health Related Social Needs (HRSN) services in Oregon. That approval does not get into an excruciating level of detail about how the HRSN services will be provided. While it does set up guardrails, Oregon Health Authority (OHA) ultimately determines the protocols, rules, and operations involved in actually delivering HRSN services.

Note, while OHA is the governing authority, they are not your primary point of contact for HRSN services. Your Coordinated Care Organization (CCO) will serve as your primary point of contact.

Medicaid

Each state has the option to use federal funds to provide a basic level of affordable and accessible healthcare to lower income and at-risk populations. Note, this is different from Medicare, which is primarily for the elderly. Oregon’s Medicaid plan is called Oregon Health Plan.

Oregon Health Plan - OHP

Oregon’s implementation of Medicaid. Note, this is different from Medicare, which is primarily for the elderly. Medicaid is for lower income and at-risk populations to have some level of assurance for affordable and accessible healthcare.

1115 Waiver

Every 5 years, states can seek approval from federal partners to offer experimental services and rules related to their Medicaid program. This guide focuses on the approvals related to Health Related Social Needs (HRSN). However, the current waiver from 2022 includes several other unrelated changes, like automatic renewal for children, and expanded eligibility to all services for some services.

While HRSN is the highlight change for this waiver, It’s just important to know that if someone is talking about the “1115 Waiver,” they aren’t necessarily talking about HRSN. The 1115 Waiver intentionally does not get into an excruciating level of detail about how the HRSN services will be provided. While it does set up guardrails, Oregon Health Authority (OHA) ultimately determines the protocols, rules, and operations involved in actually delivering HRSN services.

Health Related Social Needs - HRSN

Health Related Social Needs are factors outside of actual medical diagnoses that impact a person's health an wellbeing. In the context of the 1115 Waiver, these are protecting people from the impacts of climate change, their housing status, and their nutrition.

Coordinated Care Organizations - CCO

While Oregon's Medicaid plan, Oregon Health Plan (OHP), is governed by the Oregon Health Authority (OHA), the actual benefits are administered by 16 organizations, defined by territory, across the state. Think of OHA as the referee and the CCOs as the players in the system. They get OHP members enrolled, individualized health plans, coordinate their services, and measure outcomes, all reporting and billing to OHA.

CCOs can subcontract with other organizations like Community Based Organizations (CBOs). So you may meet CBOs who say they are administering certain services for OHP members, they are likely contracted with a particular CCO to achieve their obligations to OHA.

The contact for these CCOs can be found here.

Open Card

All Oregonians who want to be on the Oregon Health Plan (OHP) have the option of contracting directly with the state, instead of a Coordinated Care Organization (CCO). These members are called "Open Card." This means that instead of the CCO managing the members care, measuring outcomes, and getting reimbursed, the member does so directly to Oregon Health Authority (OHA).

Roughly 10% of the OHP, or 140k members, are Open Card members. But because you won't know whether someone is Open Card, or a member of a CCO (and they may not know themselves!) it is recommended that you become familiar with, and qualify for, services for both CCO and Open Card members. The HRSN services and qualification rules are the same. But the processes involved in referrals, billing, and data reporting requirements may be different.

Community Based Organizations - CBO

Most frequently, a Community Based Organization (CBO) will be a formal 501(c)3 non-profit. These organizations operate at the community or regional level to either directly provide, or connect their neighbors to services like housing, healthcare access, or food. On the other end of the spectrum, a CBO could be a less formal organization to keep members of the same apartment complex connected, informed, and supportive of each other.

In the context of 1115/HRSN, CBOs will be the primary organizations actually delivering HRSN services, managed and contracted with a Coordinated Care Organization (CCO).

HRSN Service Provider

A Community Based Organization (CBO) that has enrolled to be a provider with Oregon Health Authority (OHA) and contracted with a Coordinated Care Organization (CCO) to provide HRSN Services.

HRSN Connector

A Community Based Organization (CBO) or individual that has a relationship with a Coordinated Care Organization (CCO) or HRSN Service Provider to refer Oregon Health Plan (OHP) patients for HRSN benefits. Almost anyone can be an HRSN Connector, it just takes understanding the opportunities and qualifications of the program as well as relationships with CCOs/HRSN Service Providers who can help further.