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Date Last Updated: CMCS, CAHPG, DCHIP, June 09, 2011 Administration
• The program is administered by the State’s Division of Medical Assistance Programs (DMAP) within the Department of Human Resources.
Health Care Delivery System
• The State utilizes the same delivery system for CHIP as it uses for its section 1115 Medicaid managed care delivery system, the Oregon Health Plan (OHP), to deliver services. The delivery system is comprised of prepaid health plans and primary care case managers.
Benefit Package
• The separate child health program offers Secretary-approved coverage that is the same as coverage offered under the State’s Medicaid program. The State’s benefit package is based on the OHP Prioritized List of Health Services which is a modified Medicaid benefit package as allowed under Oregon’s section 1115 Medicaid demonstration waiver for its entire Medicaid population. Medically necessary services are defined in the Prioritized List.
• The comprehensive benefit package includes case-management, preventive health care, interpreter, and non-emergency transportation services at no additional cost.
• Benefits for the unborn population include prenatal care and associated health care services. The program will cover medically necessary services including, but not limited to: physician, surgical, prescription drug, inpatient, outpatient, prenatal care, radiology, and laboratory services.
Cost Sharing
• There are no premiums, copayments, or deductibles for enrollees.
State Action to Avoid Crowd-Out
• Information on current or previous health insurance is gathered on the application. Children are not eligible if they have been enrolled in private insurance within the past 6 months, except in cases of a life-threatening or disabling condition. The State monitors substitution under its Quality Control and Quality Assurance process to analyze the extent to which an applicant drops other health plan coverage.