PA Specialist Corner: Work Activity Rules & OHP Update, What to Do Next
More on Work Activity Rules & OHP
As discussed in our previous newsletter, changes are coming to the Oregon Health Plan (OHP) as a result of House Resolution 1, also known as the One Big Beautiful Bill Act.
Starting January 1, 2027, new work activity rules will affect some people who apply for OHP and some current members when they renew their coverage.
OHP will start sending notices to members who will be affected by the work activity rules in late September and early October 2026.
Which OHP Programs are Affected?
Some OHP members are automatically excluded from work activity rules. This includes members who qualify for OHP because they receive federal disability benefits or Medicare. These members receive OHP through the OSIP-M program, also known as the Oregon Supplemental Income Program Medical with Services.
People who qualify for OHP through other programs may be affected by the work activity rules. These programs include:
MAGI (Modified Adjusted Gross Income)
Healthier Oregon
Young Adults with Special Health Care Needs, if they do not also qualify for OSIP-M
If you are not sure which program you qualify for OHP through, check your most recent OHP approval letter. You can also ask your Personal Agent to check with one of our Medicaid Assisters at Community Pathways.
Exemptions
OHP members who are not automatically excluded from work activity rules may qualify for an exemption.
For more information about exemptions and the documentation you may need, go to www.oregon.gov/oha/HSD/OHP/Documents/Work-Activity-Exemptions.pdf
How to Meet Work or Activity Rules
Starting in 2027, when someone applies for OHP or renews their coverage and doesn't have an exemption, the ONE Eligibility system will check to see if they have met one of the work or activity requirements during the lookback period.
New Applicants: The system will check whether they met the work or activity requirements during the month before they applied.
Renewing Members: The system will check whether they met the work or activity requirements during any one of the six months before their renewal date.
Many people who work already meet the requirements. For example, the rules can be met by:
Having a gross household income over $580.
Working more than 80 hours in a month.
Being enrolled in high school or a GED program.
Being enrolled in higher education at least half time.
Completing at least 80 hours of unpaid work like volunteering or caregiving.
Doing unpaid work in exchange for housing.
Any of these activities can be combined to reach the 80-hour requirement.
What to Do Next
The most important thing to remember is to watch for letters from the Oregon Health Plan and respond promptly.
If you receive a notice and are not sure what to do, ask your Personal Agent for help.
Written by Christine Xthona, Personal Agent (PA) Specialist at Community Pathways.
Do you have a question for our PA Specialists?
Send any questions you might have about disability services, including Community Pathways’ brokerage support services, to info@communitypath.org.
Our PA Specialists will try there best to respond to the questions we get by sharing helpful information and resources in an upcoming blog post. Thank you!