Oregon Health Authority update for January 2026
Quick Summary: 2026 OHA Payment Changes
For Oregon Behavioral Health Providers (OHP/CCO)
Applies January 2026
🔍 What’s Happening
The Oregon Health Authority (OHA) is changing how it structures behavioral health payments for providers who serve Oregon Health Plan (OHP) members.
Funding is NOT being cut.
What’s changing is who qualifies for the enhanced (higher) payment protection.
This affects how CareOregon, PacificSource, and other CCOs pay behavioral health providers like MTPNW.
đź’ˇ What It Means for MTPNW
Right now, OHA requires CCOs to pay most Medicaid-heavy clinics at least 110% of the OHP rate.
Starting in 2026, that rule will only apply to clinics that meet OHA’s new definition of “Team-Based High Acuity Providers.”
To qualify, an organization must:
✅ Hold a Certificate of Approval (COA) — MTPNW already has this
✅ Earn 50%+ of revenue from OHP members — MTPNW qualifies
âś… Provide team-based, integrated care, including:
A psychiatric provider (MD, NP, or PA)
Peer support services
Case management
If we don’t offer those services directly or through formal partnership, we’ll lose the 110% payment protection — but we can still negotiate strong rates with our CCOs.
đź’¬ What This Means for You
There will be no interruption to pay or contracts right now.
This change is effective January 2026, and the clinic will prepare well before that.
OHA is still finalizing details and awaiting federal approval.
This is about how funds are directed, not about cutting behavioral health budgets.
⚙️ What MTPNW Is Doing
Monitoring OHA’s final guidance (due late 2025)
Exploring formal partnerships for psychiatry (this will be the most “difficult” to secure since the other two requirements we can do in-house), peer support, and case management
Maintaining active CCO contracts and ensuring rates stay stable
Preparing for possible documentation or attestation updates in 2025
đź’¬ The Takeaway
This is an administrative funding shift, not a threat to MTPNW’s stability.
We’ll continue to provide accessible, high-quality care for OHP members — and we’re planning ahead so practitioners stay supported, paid, and informed every step of the way.