MedicaidCoverageMedium impact
Provider Announcement
Oregon Health Plan·OR·Community partner
Effective date
Apr 2, 2020
We identified it
Jun 20, 2026
Summary
Effective immediately, Oregon Health Authority is allowing OHP-certified community partners to perform Presumptive Eligibility (PE) determinations for temporary Oregon Health Plan coverage during the COVID-19 pandemic. Community partner assisters with active assister IDs must complete DHS/OHA training to enroll applicants using hospital PE forms. This expands PE determination authority beyond hospitals to community organizations.
Action Required
Immediately: Billing and eligibility teams should note that community partner organizations in Oregon may now initiate Presumptive Eligibility determinations for OHP coverage. When claims arrive from community partner-referred patients with PE coverage, verify that the referring organization had an active assister ID and completed required DHS/OHA training. Coordinate with community partners to ensure they are directing patients to complete full OHP applications via the ONE Applicant Portal when possible, as PE is temporary and full applications are required for continued benefits. Update internal referral and eligibility verification processes to recognize community partner PE determinations as valid coverage triggers. No billing code changes are required, but claims processors should be prepared to handle a higher volume of PE-initiated coverage from non-hospital sources.