MedicaidCoverageMedium impact
Change to coverage of COVID-19 home test kits effective March 1, 2026
Oregon Health Plan·OR·Plan contract
Effective date
Mar 1, 2026
We identified it
Aug 19, 2026
Summary
Oregon Health Plan (OHP) is reducing COVID-19 home test kit coverage from 8 kits per member per month to 4 kits per member per month, effective March 1, 2026. No prior authorization or primary care provider order is required. Additionally, COVID-19 home test kits are clarified as NOT qualifying as an In Lieu of Service, superseding prior guidance from February 2022.
Action Required
By February 28, 2026: Billing and claims teams must update systems and workflows to reflect the new limit of 4 COVID-19 home test kits per OHP member per month (down from 8). Update claim submission rules in billing software to enforce the 4-kit limit and deny claims exceeding this threshold. Notify providers and front desk staff of the coverage change. Remove any documentation stating COVID-19 home test kits qualify as In Lieu of Services from internal references and prior guidance. Ensure no prior authorization requirement is applied, as these kits continue to be covered without PCP order or prior auth. Failure to apply the new limit will result in claim denials and potential overpayments.