MedicaidCoverageMedium impact
Young Adults with Special Health Care Needs benefits effective Jan. 1, 2025
Oregon Health Plan·OR·Provider
Effective date
Jan 1, 2025
We identified it
Jun 20, 2026
Summary
Oregon Health Plan launches Young Adults with Special Health Care Needs (YSHCN) benefits effective January 1, 2025, providing enhanced vision, dental, and EPSDT coverage for eligible 19-20 year olds with qualifying health conditions and income at or below 205% of Federal Poverty Level. This expands comprehensive healthcare coverage for young adults transitioning from pediatric care.
Action Required
By January 1, 2025: Billing team must identify eligible Oregon Health Plan members ages 19-20 with qualifying health conditions and verify YSHCN enrollment status before billing enhanced vision, dental, or EPSDT services. Update billing system to recognize YSHCN benefit package. Contact member's CCO for coverage verification and billing questions for CCO members, or Provider Services Unit at dmap.providerservices@oha.oregon.gov for fee-for-service members.