MedicaidCoverageMedium impact
Ensuring Oregon Health Plan coverage of medical grade formula
Oregon Health Plan·OR · Pediatrics, Gastroenterology, Family Medicine·Plan
We identified it
Jun 20, 2026
Summary
Oregon Health Plan (OHP) has clarified that it serves as the primary payer for medical grade formula and nutritional supplements before WIC for eligible children. This is a reminder of existing rules, with urgency due to potential WIC funding interruption from federal government shutdown.
Action Required
Immediately: For Oregon providers serving children with medical formula needs - verify OHP coverage before billing WIC. Contact child's CCO or OHA for approval of medically necessary formula/supplements. CCOs should expedite prior authorization processes per OAR 410-148-0260. Check with CCO/OHA if unsure about existing coverage status.