MedicaidCoverageHigh impact
Provider guide regarding services to OHP Children and Youth: Early and Periodic Screening, Diagnosis and Treatment (EPSDT)
Oregon Health Plan·OR·Provider
Effective date
Jan 1, 2023
We identified it
Jun 20, 2026
Summary
Effective January 1, 2023, Oregon Health Plan (OHP/Medicaid) must now cover ALL medically necessary services for children under 21 regardless of the state's Prioritized List, eliminating previous coverage restrictions. Providers must document medical necessity for all EPSDT services and update contact information for prior authorization requests.
Action Required
Immediately: Billing team must update contact information with OHA Provider Enrollment at 1-800-336-6016 Option #6 or provider.enrollment@odhsoha.oregon.gov for processing prior authorization requests. Stop refusing services to OHP members under 21 based on Prioritized List placement. Ensure all claims for members under 21 include documentation of medical necessity and appropriateness, regardless of pre-set limits or guidelines. Contact EPSDT.Info@odhsoha.oregon.gov with questions.