Overview
The Oregon Health Authority (OHA) contracts with coordinated care organizations or CCOs. CCOs manage and deliver health care for most people eligible for the Oregon Health Plan (OHP). OHA pays CCOs to cover these individuals with capitation rates.
- Capitation rates are a predetermined payment that depends on the individual's OHP eligibility status.
- OHA pays capitation rates to CCOs on a monthly basis dependent on enrollment.
OHA's contracted actuaries develop and certify CCO capitation rates on a yearly basis. Federal and state regulations govern the process and methodology used to develop capitation rates. The Centers for Medicare & Medicaid Services (CMS) requires Oregon's capitation rates be actuarially sound and follow applicable Actuarial Standards of Practice developed by the
Actuarial Standards Board.
Medicaid Capitation Rate Reports
Healthier Oregon Capitation Rate Reports
Basic Health Program Capitation Rate Reports
Health-Related Social Needs
Contract Rate Sheets