MedicaidCoverageHigh impact
Planned Parenthood claims
Oregon Health Plan·OR·Plan
Effective date
Jul 4, 2025
We identified it
Aug 19, 2026
Summary
Effective July 4, 2025, Oregon Medicaid (CCOs) must hold all claims from Planned Parenthood of the Columbia-Willamette (PPCW) and Planned Parenthood of Southwestern Oregon (PPSO) with dates of service on or after July 4, 2025, due to federal restrictions under the One Big Beautiful Bill Act. Claims must not be submitted to OHA for payment or encounter data processing until further guidance is provided. This applies only to CCO Medicaid Contract members, not Non-Medicaid or Oregon Health Plan Bridge members.
Action Required
Immediately (by July 9, 2025 or as soon as possible): 1) Billing team must configure claims processing system to automatically hold (do not pay or submit) all claims from PPCW and PPSO with service dates on or after July 4, 2025. 2) Billing team must remove held encounter data from any CCO Medicaid Contract submissions to OHA if claims were already paid. 3) Compliance/management must distribute this memo to all relevant billing staff, providers, subcontractors, and member-facing teams. 4) Customer service/member support must be prepared to reassure members that they may continue accessing services from Planned Parenthood during this hold period; services continue but claims processing is delayed pending federal guidance. Do not process, pay, or submit encounter data for affected claims until OHA provides updated guidance. Failure to hold claims will result in OHA directing the CCO to void the associated encounter data.