Medicaid Redetermination: What You Need to Know

During the COVID-19 pandemic, most Oregon Health Plan (OHP) members kept their medical and other benefits even if they had a change in their life, such as a temporary change in income, or if they did not respond to a renewal request. This was because of temporary policy changes under the COVID-19 Public Health Emergency (PHE), which will now be ending on May 11, 2023. In preparation for these changes, Oregon will start reviewing eligibility of all people receiving OHP/Medicaid benefits and will be sending out renewal notices to recipients. The letters will tell you the next steps that you will need to take to keep your medical benefits. *Reminder that for many people the services you receive from Community Pathways are tied to your OHP medical benefits.

For some people, the state may need more information to see if you still qualify for OHP or other benefits, including services and supports for people with disabilities and older adults, and help paying Medicare costs. If the state can’t reach you, you could lose your benefits, even if you still qualify.

This redetermination process will happen for everyone on OHP even if you recently went through a redetermination process. Oregon Department of Human Services (ODHS) has warned that some people may end up going through this process twice.

This is what you can do to prepare for your upcoming OHP/Medicaid Redetermination:

  • Keep your contact information up to date – Make sure ODHS has your current mailing address, phone number, email or other contact information using the link below. This way, the state will be able to contact you about your benefits. Find options for updating your contact information online, by phone, or in person at Oregon.gov/OR-benefit-changes.

  • Check your mail – The state (ODHS) will contact you by mail if they need more information from you. A letter will let you know if you need to complete a renewal form to see if you still qualify for OHP or other benefits.

  • Respond to information requests and submit renewal forms right away, if you get them – Responding to information requests and filling out and submitting renewal forms right away will help you avoid a gap in your benefits. If you need help and would like someone else to be able to talk with ODHS about your benefits, you may assign an authorized representative who can be a family member or friend you choose to help you.

  • Understand the timelines for renewing your OHP/Medicaid benefits –

  • Initial Renewal Notice mailed out between April 2023 and January 2024.

  • Reminder Notice mailed out 60 days after Initial Notice.

  • Second Reminder Notice mailed out 30 days after first Reminder Notice.

  • Renewal period will end 30 days after Second Reminder Notice was mailed out if you have not responded to any of the notices.

  • 60-day period of continued benefits begins where you will still keep your benefits but need to respond to the renewal notices you already received.

  • OHP/Medicaid benefits end after the 60-day period of continued benefits concludes.

  • 90-day reconsideration period begins where you no longer have benefits, but you do not need to complete a new application if you contact ODHS to start your OHP/Medicaid benefits up again.

  • After this, a new application will need to be submitted if you want to receive medical benefits again.

The simplest and easiest way to make sure there are no delays or loss of service is to respond to the requests from Oregon Department of Human Services (ODHS) as soon as possible. Remember, you can contact your PA if you have any further questions about how to complete the redetermination of your OHP/Medicaid benefits. We are here to help!