MedicaidCoverageHigh impact
Update # 4 regarding Planned Parenthood claims memo 09162025
Oregon Health Plan·OR · OB-GYN, Family Medicine, General Practice +1 more·Plan contract
Effective date
Sep 16, 2025
We identified it
Aug 19, 2026
Summary
Effective immediately, Oregon CCOs must hold all unadjudicated Planned Parenthood claims for Medicaid members with service dates on or after July 4, 2025 (excluding HOP members), pending further direction from OHA following a federal court decision. Previously adjudicated claims should not be reprocessed. Claims for Non-Medicaid contracts, Bridge Basic Health Program, and HOP members continue processing normally.
Action Required
Immediately: Billing team must implement a hold on all unadjudicated Planned Parenthood claims for Medicaid members with dates of service on or after July 4, 2025 in the billing system. Configure system rules to automatically hold these claims pending further OHA direction. Do NOT reprocess or touch any previously adjudicated Planned Parenthood claims. Verify that claims for Non-Medicaid contracts, Oregon Health Plan Bridge Basic Health Program, and HOP members continue to process normally. Monitor email from Medicaid.Programs@odhsoha.oregon.gov for Update #5 with additional guidance. Failure to implement this hold may result in claims being improperly adjudicated during active litigation and potential payment clawbacks.