Oregon Health Authority Prepares Oregon Health Plan Members for Upcoming Federal Rule Changes

Oct 29, 2026 | AOC Business Partner

Sponsored content contributed by AOC Business Partner: Oregon Health Authority

The Oregon Health Authority (OHA) is gearing up for a major shift in how some adults ages 19–64 qualify for Oregon Health Plan (OHP / Medicaid) coverage, as new federal requirements take effect in January 2027. These updates stem from House Resolution 1 (HR1), a federal law mandating changes to Medicaid programs nationwide.

Under the new rules, certain OHP members will need to meet work or activity rules when applying for or renewing their benefits. Members can meet the rules by having a monthly income of at least $580, being enrolled in school half-time, or completing a mix of work, volunteering, education, or training totaling 80 hours per month.

These requirements will not apply to everyone. Many members—such as those who are pregnant, enrolled in Medicare, qualify based on disability, or have serious medical needs—are exempt.

Caregivers, veterans with total disability ratings, and American Indian/Alaska Native members are also among those who may qualify for exemptions. OHP members may need to provide more information or provide proof to meet an exemption.

Notices sent to members this fall

OHP started sending informational notices to about 600,000 members in October 2026. These early alerts are meant to help people understand whether the changes could affect them and what steps they may need to take before their next renewal.

Keeping contact information current remains one of the most important actions members can take to avoid communication gaps.

Local impact and how counties can help

Counties could play an important role in helping members through these shifts. Local offices will be a resource for OHP members who need help updating information, understanding exemption requirements, or gathering documents.

 Starting in January, counties can connect residents with community partners, workforce organizations, or education and volunteer programs to meet the new requirements. If OHP members have questions about the new requirements, counties should direct them to an OHP assister or ODHS. Given the very detailed nature of the new rules, we want to make sure that OHP members have the most accurate, timely information possible. 

Here is how OHP members can get additional information:

• Go to benefits.oregon.gov
• Call 1-800-699-9075 (relay calls welcome)
• Visit an Oregon Department of Human Services office.
• Find a local office at ODHSoffices.oregon.gov
• Find an OHP assister who can help at oregonhealthcare.gov/gethelp

Stay Connected. Stay Covered.

To support partner organizations and members alike, OHA launched Stay Connected. Stay Covered, a campaign to share updates through web pages, newsletters, and social media. This includes tools, sample notices, and materials that partners can use in their own outreach efforts. We encourage counties to put up these posters or to have pocket cards available for OHP members. 

What comes next

Many OHP members will keep their coverage, but the new rules mean that some people may have to renew more frequently or provide new documentation. Counties can help members stay covered by emphasizing the need for accurate contact information and directing them to experts. 

In October, OHA, in partnership with Oregon Department of Human Services (ODHS), launched a new monthly bulletin to share information and resources about federal changes to OHP with partners. Subscribe to the bulletin here.

These changes will be a major transition for many OHP members. Counties can help soften the impact by learning the new rules and clearly communicating with members to help ensure communities remain connected to essential health coverage.

Resources

• Sign up for Oregon Health News
• Visit the HR1 Web Page 
• Instagram: @OregonHealthAuthority
• Oregon Health Authority Facebook (English) 
• OHA en Español Facebook (Spanish) 
• OHA’s Toolkit on Federal Changes web page

Health Care Costs Keep Rising: How CIS is Responding

Oct 29, 2026 | AOC Business Partner

Sponsored content contributed by AOC Business Partner: CIS

Oregon’s counties are facing difficult budget decisions. Health care costs continue to rise faster than revenues, putting additional pressure on already-tight county budgets. At CIS, we understand that pressure. Every premium dollar comes from a local government budget, and every dollar must deliver value.

That’s why affordability remains a top priority for CIS. We’ve reduced administrative expenses and made some difficult decisions to help keep rate increases as low as possible while protecting the program’s long-term sustainability. But the numbers tell an important story: CIS directly controls only about 7% of premium costs. The remaining 93% goes toward health care itself, including hospital services, physician care and prescription drugs.

We’ve worked hard to reduce the 7%. Now we need to focus on the 93%.

That means looking at how care is delivered, managed and paid for. CIS has strengthened pharmacy and utilization management, continued programs such as Lantern that help eligible members access high-quality surgical care, and offered plan options such as Surest that give members more information about costs before receiving care. We continue to evaluate other approaches that can improve affordability while preserving access and choice.

It also means addressing challenges no single employer can solve alone. CIS is working with AOC and the League of Oregon Cities (LOC) to address broader health care costs, particularly hospital costs that continue to rise faster than inflation. Together, we’re working to help policymakers understand how these increases affect local government budgets and the services our communities depend on. Our goal is to find practical, long-term solutions that make health care more affordable for Oregon’s counties and cities. Every additional dollar absorbed by health care costs is a dollar local governments cannot invest in public safety, infrastructure and the other services their communities rely on.

As a member-owned risk pool, CIS is not driven by profits or shareholders. Our focus is on providing dependable coverage, managing costs and delivering value to our members. Pooling our resources and expertise gives us greater buying power and a stronger collective voice. There is no single solution to rising health care costs, but we can keep looking for practical ways to make coverage more sustainable for members.

Learn More at the CIS 25th Annual Conference

The affordability conversation will continue at the 25th CIS Annual Conference, Feb. 24-26, 2027, at the Salem Convention Center. The conference will feature benefits sessions focused on what is changing and what employers can do to help manage costs.

What’s New in Benefits

CIS Benefits Director Mike Beyrouty will review key changes for 2027 and provide a look at issues the Benefits team and Board are evaluating for 2028 and beyond. Attendees will also hear updates on compliance, coverage, plan administration and other initiatives affecting CIS Benefits members.

Claims, Costs and Choices: What Employers Can Do to Make a Difference 

Representatives from CIS medical carriers will discuss practical strategies employers can use to encourage employees to make better use of available plan resources, preventive care and cost-transparency tools. The session will focus on actions that can improve engagement with benefits and help manage claims costs over time.

Registration goes live the first week of December. Visit cisoregon.org/conference for the latest agenda, speaker information and registration.

Health care costs remain one of the most significant financial challenges facing Oregon’s counties. We cannot control every part of the market. But we can be clear about what’s driving costs, manage what we can control and work together to address the challenges we can’t solve alone.

That’s the value of working together as a member-owned risk pool: helping Oregon’s local governments become safer, stronger and healthier.