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36 Chapter 1: Introduction to the Oregon Programs Eligibility Notebook • Section 1: Intent and overview of programs (07/2026) foster care in any state and were receiving Medicaid coverage while in care. This includes children who were in Oregon Youth Authority (OYA) foster care. • MAGI Adult (AMO) is for individuals 19 years of age or older and less than age 65 with a household income at or below 138% of the federal poverty level. The Young Adults with Special Health Care Needs (YSHCN) Program As part of Oregon’s 2022-2027 1115 waiver, the Young Adults with Special Health Care Needs (YSHCN) program was created January 1, 2025. The program was initially only available for individuals aged 19 – 20 who meet certain qualifying health conditions that began prior to the person turning 19. Starting January 1, 2026, the program is now available to individuals aged 19 – 21. More age groups are expected to be added each calendar year, depending on available funding (i.e. those 19 – 22 could be eligible in 2027, etc.). Once determined eligible, individuals are allowed to continue receiving YSHCN coverage through age 25, as long they continue to qualify at each redetermination. The goal of the program is to improve health outcomes for young adults with special health care needs by expanding access to OHP eligibility and to help bridge the transition for children to young adulthood by providing OHP’s enhanced benefit package through age 25. YSHCN individuals have Continuous Eligibility (CE) protections. While individuals can remain eligible for YSHCN through age 25, they must undergo regularly scheduled renewals at the end of their certification or CE periods, and they must continue to meet ongoing eligibility requirements to maintain coverage. While YSHCN is a new standalone program in the medical hierarchy, it is also a supplemental benefit available to those who are already eligible for an existing OHP Plus/Healthier Oregon program. The YSHCN benefit enhances OHP Plus/Healthier Oregon benefits by adding Early Periodic Screening and Diagnosis (EPSDT), enhanced vision/ dental, and automatic screening for Health Related Social Needs (HRSN). EPSDT is coverage for all medically necessary and medically appropriate supports or procedures for children and youth. EPSDT and enhanced vision/ dental is otherwise only available to those under 21 or pregnant individuals. YSHCN provides these additional benefits through age 25. Specific eligibility criteria for YSHCN includes: • Age: Currently, the program is available to those aged 19 – 21 (but these individuals can keep benefits through age 25 as long as they remain eligible). • Income: The income requirement can be met in one of two ways: People can get YSHCN as a supplemental benefit if they meet financial requirements for another OHP Plus/Healthier Oregon program; or If not eligible for any other OHP Plus/Healthier Oregon program, people can get YSHCN as a primary benefit if they have income equal to or less than 205% FPL (includes a 5% disregard). • Health condition(s) that started before turning age 19: Health conditions include a complex chronic illness, behavioral health condition, or diagnosed intellectual or developmental disabilities. Individuals must meet one of three pathways to meet the health condition requirement: Have been determined eligible for services or have a qualifying I-DD diagnosis by the Office of Developmental Disability Services (ODDS) as of age 16 or later (identified via SELG record in ONE and via reports);