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Medicaid Benefits in Oregon

Oregon residents who cannot afford private health insurance may qualify for coverage through the state's Medicaid program. Even though Medicaid is a federal program, the state sets its own eligibility criteria. If you determine that you meet the qualifications for Medicaid benefits, you can submit an application for Medicaid through the Oregon Department of Human Services.

  1. Eligibility Groups

    • To be eligible for Medicaid benefits in Oregon, you must reside in the state. You must be a U.S. citizen who falls into one of several eligibility categories. Medicaid is open to pregnant women, infants, children age 19 and under, parents or legal guardians of children living in the household, adults over age 65 and disabled or blind. Disabilities must be confirmed by the Social Security Administration. Legal residents who are not citizens are sometimes eligible.

    Income Limits

    • All sources of income are considered in calculating the total gross income for a household. Income is limited to a specified percentage of the Federal Poverty Level (FPL) based on the number of people in the household. If you are applying for a child age five or under, the income cannot exceed 133 percent of the FPL. The income limit for parents and children under 18 is 100 percent. Pregnant women are allowed 185 percent of the FPL. Applicants who exceed the income limits may qualify for coverage as a medically needy applicant. Individuals with high medical bills can deduct those expenses from their income. To be eligible, the resulting balance cannot surpass 58 percent of the FPL. The cutoff for medically needy couples is 54 percent.

    Services Covered

    • Oregon Medicaid covers a variety of services for routine care or specialized treatment. Doctor visits, emergency room care, x-rays, lab work, screening and family planning are covered, in addition to physical, speech and occupational therapy. Necessary medical transportation, including ambulance or taxi service, is also covered. Routine and emergency dental service is covered. Hospice and nursing-home care is available to individuals deemed in need of these services.

    Applying for Medicaid

    • You can obtain a Medicaid application by visiting an Oregon Department of Health Services or Oregon Health Plan outreach site, such as a hospital or county health department. The state website allows you to add your name to the OHP Standard reservation list to receive an application in the mail. Prepare to submit proof of identity, citizenship and finances. Applications are processed within 45 days. If you are disabled, the processing can take longer.

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