History of EPSDT Coverage in Oregon
OHP has covered most EPSDT services for a long time. However, Oregon's past OHP 1115(a) Medicaid waivers before meant that some services were not covered. Oregon did not renew the longstanding waiver around EPSDT coverage. The decision came as a result of clear feedback from the community, advocates, children's service organizations, and other interested parties. Beginning Jan. 1, 2023, OHA and CCOs must cover all medically necessary and medically appropriate services for OHP members under age 21, regardless of placement on the
Prioritized List of Health Services. Medical necessity and medical appropriateness are determined on a case-by-case basis, taking into account the member's needs.
States must cover all medically necessary and medically appropriate services that are part of the federal EPSDT benefit, even if the service is not available or defined under the state's Medicaid plan.
Beginning Jan. 1, 2025, OHP members with YSHCN benefits also receive EPSDT coverage. This expansion is authorized by Oregon's 2022-2027 1115(a) Medicaid waiver.
Member Resources
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Guidance
Change log of guidance updates (1/17/2025)
EPSDT Guidance for OHP providers (1/17/2025)
Provider billing guide (11/18/2024)
OHA policy regarding enclosed safety beds (11/1/2024)
OHA lead testing and screening requirements and recommendations (9/9/2024)
Frequently Asked Questions (12/30/2024): English and Spanish
EPSDT Guidance for CCOs (updated 10/28/2024)
Provider memo (11/25/2023)
Provider webinars:
LPHA Provider Education Session on Lead Investigation Reimbursements
EPSDT Overview and Open Card Process Updates:
EPSDT for Behavioral Health and Behavior Rehabilitation Service providers:
EPSDT Overview webinar:
EPSDT Ensuring Access webinar: