Oregon Medicaid (Oregon Health Plan) Eligibility Guide
This guide provides comprehensive information about Medicaid eligibility in Oregon, known as Oregon Health Plan. Whether you're a child, parent, pregnant woman, or adult, this guide will help you understand if you qualify for Oregon Health Plan coverage and how to apply.
Oregon has expanded Medicaid under the Affordable Care Act (ACA), which means most adults with income up to 138% of the Federal Poverty Level (FPL) can qualify for Medicaid. This expansion has significantly increased access to healthcare coverage. In expansion states like Oregon, there is generally no asset test for MAGI-based Medicaid programs (those for children, pregnant women, parents, and other adults under 65).
Important Note: Medicaid eligibility rules and income limits are subject to change. For the most up-to-date information, please contact the Oregon Health Plan office at 1-800-699-9075 or visit www.oregon.gov/oha/HSD/OHP.
General Eligibility Requirements
To qualify for Oregon Medicaid (Oregon Health Plan), you must:
- Be a resident of Oregon
- Be a U.S. citizen or have qualified immigration status
- Have or apply for a Social Security number (with some exceptions)
- Meet the specific eligibility criteria for at least one Medicaid pathway
- Meet income guidelines (which vary by program)
Note: This guide covers the main Medicaid eligibility categories for children, pregnant women, parents, and adults. Additional pathways exist for seniors (65+), people with disabilities, and those with specific medical conditions. These specialized programs often have different income and asset requirements not detailed in this guide.
Medicaid Eligibility Pathways in Oregon
Oregon offers several pathways to Medicaid eligibility, each with specific requirements. Please note, a 5% income disregard may already be included or can be applied depending on circumstances.
1. Medicaid for Children
Who Qualifies:
- Children under age 19
- Oregon residents
- U.S. citizens or those with qualified immigration status
- Meeting income guidelines
Income Limits:
- Infants up to age 1: Up to 190% FPL
- Children ages 1-18: Up to 305% FPL
| Family Size | Infants up to age 1 (190% FPL) | Children ages 1-18 (305% FPL) |
|---|---|---|
| 1 | $2,478 | $3,977 |
| 2 | $3,350 | $5,377 |
| 3 | $4,220 | $6,774 |
| 4 | $5,090 | $8,171 |
| 5 | $5,962 | $9,571 |
| 6 | $6,832 | $10,968 |
| 7 | $7,703 | $12,365 |
| 8 | $8,575 | $13,765 |
| Each Additional Person | +$870 | +$1,397 |
2. Children's Health Insurance Program (CHIP)
Who Qualifies:
- Children under age 19
- Family income above Medicaid limits but at or below 305% FPL
- Oregon residents
- U.S. citizens or those with qualified immigration status
- No other insurance coverage
Income Limits:
Above Medicaid limits up to 305% FPL
3. Medicaid for Pregnant Women
Who Qualifies:
- Pregnant individuals
- Oregon residents
- U.S. citizens or those with qualified immigration status
- Meeting income guidelines
Income Limits: 190% of FPL
| Family Size* | Monthly Income Limit | Annual Income Limit |
|---|---|---|
| 2 | $3,350 | $40,200 |
| 3 | $4,220 | $50,640 |
| 4 | $5,090 | $61,080 |
| 5 | $5,962 | $71,544 |
| 6 | $6,832 | $81,984 |
| 7 | $7,703 | $92,436 |
| 8 | $8,575 | $102,900 |
| Each Additional Person | +$870 | +$10,440 |
*Note: Unborn child is counted as a family member when determining family size.
Important: Coverage extends for 12 months postpartum in Oregon.
Presumptive Eligibility: Temporary coverage for outpatient prenatal services while the full application is being processed.
4. Medicaid for Adults
Who Qualifies:
- Adults ages 19-64
- Not eligible for Medicare
- Oregon residents
- U.S. citizens or those with qualified immigration status
- Meeting income guidelines
Income Limits: 138% of FPL
| Family Size | Monthly Income Limit | Annual Income Limit |
|---|---|---|
| 1 | $1,800 | $21,600 |
| 2 | $2,433 | $29,196 |
| 3 | $3,065 | $36,780 |
| 4 | $3,697 | $44,364 |
| 5 | $4,330 | $51,960 |
| 6 | $4,962 | $59,544 |
| 7 | $5,595 | $67,140 |
| 8 | $6,228 | $74,736 |
| Each Additional Person | +$632 | +$7,584 |
How Income is Counted for MAGI-based Healthcare Programs
Understanding how your income is counted is important for determining eligibility for Medicaid and other healthcare programs. Medicaid income limits are based on MAGI (Modified Adjusted Gross Income). To learn how MAGI income is calculated see: How Income is Counted for MAGI
How to Apply for Oregon Health Plan
There are several ways to apply for Medicaid in Oregon:
- Online: Visit www.oregon.gov/oha/HSD/OHP
- By Phone: Call 1-800-699-9075
- In Person: Visit your local Department of Social Services or Medicaid office
- By Mail: Request a paper application from your local Medicaid office
Affordable Care Act (ACA) Coverage
If you don't qualify for Medicaid in Oregon, you may be eligible for subsidized health insurance through the Health Insurance Marketplace.
Who Can Apply for Marketplace Coverage
Anyone who:
- Lives in the United States
- Is a U.S. citizen or national (or is lawfully present)
- Is not incarcerated
- Is not covered by Medicare
Premium Tax Credits and Subsidies
Premium tax credits help reduce your monthly insurance premiums. In Oregon (a non-Medicaid expansion state), you may qualify for premium tax credits if your income is between 100% and 400% of the Federal Poverty Level, and in some cases above 400% FPL.
| Family Size | Monthly Income at 400% FPL | Annual Income at 400% FPL |
|---|---|---|
| 1 | $5,216 | $62,592 |
| 2 | $7,052 | $84,624 |
| 3 | $8,884 | $106,608 |
| 4 | $10,716 | $128,592 |
| 5 | $12,552 | $150,624 |
| 6 | $14,384 | $172,608 |
| 7 | $16,216 | $194,592 |
| 8 | $18,052 | $216,624 |
| Each Additional Person | +$1,832 | +$21,984 |
When to Apply
- During the annual Open Enrollment Period (typically November to January)
- Within 60 days of certain life events that qualify for a Special Enrollment Period (losing other coverage, marriage, birth of a child, etc.)
How to Apply for Marketplace Coverage
- Visit Healthcare.gov
- Call the Marketplace Call Center at 1-800-318-2596
- Get in-person help from a Navigator or Certified Application Counselor (find local assistance at Healthcare.gov)
What You'll Need to Apply
- Social Security numbers for everyone on your application
- Employer and income information for everyone in your household
- Current insurance information (if applicable)
- Immigration documentation (if applicable)
Disclaimer
This guide provides general information about Oregon Medicaid eligibility based on data available as of March 2025. Eligibility criteria, income limits, and application procedures may change. Always consult the official Oregon Health Plan website or call the Oregon Medicaid (Oregon Health Plan) Recipient Call Center at 1-800-699-9075 for the most current information.
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