Oregon Health Authority outlines plan, timeline and $23.6 million request to launch state-based marketplace

The joint Ways and Means Subcommittee on Human Services heard an informational presentation April 16 from Oregon Health Authority officials on implementing a state-based health insurance marketplace and a funding request tied to House Bill 5025.

Claire Pierce Bridal, director of Health Policy and Analytics at the Oregon Health Authority, and Debbie Estabrook, chief information officer for the Oregon Health Authority and the Oregon Department of Human Services, told the committee the agency intends to launch a state-based marketplace for open enrollment beginning Nov. 1, 2026, and is seeking approval of Policy Option Package 4-24 to fund the effort.

The proposal seeks $23,600,000 in future marketplace assessment revenue and requests 15 additional positions to implement and operate the marketplace, Bridal said. The agency described the request as funding for the technology solution, a customer service center, continued independent quality management and additional staff needed to transition to maintenance and operations.

Bridal said the state-based marketplace would let Oregon customize consumer shopping and enrollment experiences that are not possible through the current federally facilitated platform, healthcare.gov. She said the marketplace office connects Oregonians who do not qualify for employer coverage or another public program to qualified health plans and that about 140,000 Oregonians signed up through the marketplace in 2025, with more than 110,000 using premium tax credits.

The agency described key milestones and governance for the project. Senate Bill 972 (2023) directed OHA to procure a marketplace solution that includes a technology platform and a customer service center, Bridal said. The project team has completed market research and business requirements in the planning phase and engaged an independent quality management vendor, Blue Crane Inc., to provide ongoing third-party reviews. The agency said it issued a request for proposals and that the Department of Administrative Services has provided a notice of intent to award; the procurement is in contract negotiations, managed by DAS.

On timing, staff said the planning phase established a baseline schedule with an early estimate range of plus or minus 50 percent; they expect to have a vendor contract in place by July or August 2025 and to narrow cost and schedule estimates to about plus or minus 10 percent after contract development. The agency targets an implementation go-live for the 2027 plan year on Nov. 1, 2026, and listed remaining implementation tasks including completing the CMS exchange blueprint application, connecting to the Federal Data Services Hub, certifying qualified health plans and completing the CMS operational readiness review.

Committee members pressed staff on procurement and risk. Senator Tim Hayden asked why the procurement remains an "intent to award"; Bridal and Estabrook said DAS is managing the active procurement, that DAS received and responded to a protest, and that negotiations are proceeding. Representative Scharf referenced Oregon’s past Cover Oregon project and asked how this effort differs; Estabrook and Bridal said the state is procuring a cloud-based, software-as-a-service platform from GetInsured that has been used by other states and does not involve a full custom build.

On costs and staffing, Bridal and Estabrook described prior and projected spending. The planning phase was funded with slightly more than $2,000,000 and supported market research, planning, vendor selection and four permanent positions. An earlier IT investment form (August 2023) estimated an implementation cost of $14,880,000 and a five-year operating cost of $79,380,000; Bridal said the current projected costs are lower than that five-year operating estimate for the new software when considered over five years. The POP 4-24 request includes a cost breakout the agency described as roughly 25% staff, 62% IT contractors and 12% other costs. The agency said it will return to the Legislature in 2026 to notice proposed changes to the marketplace assessment rate required under ORS 741.105.

The agency described specific staffing requests: the Office of Information Services received two positions in the 2023–25 biennium and is requesting six additional IT positions in 2025–27 for project management, vendor oversight, systems planning, security and integration. The marketplace program team — currently about 20 staff — requested eight new positions for partner training, appeals and complex case resolution, data management, communications and plan management; the Health Policy and Analytics business office requested one economist to assist with assessments and rate work. Bridal said these staff increases reflect responsibilities the state will assume from the federal marketplace.

Officials said the assessment that funds the project is an administrative charge assessed to carriers under ORS 741.105 and currently capped at 5% of premiums; they said the assessment rate-setting process will account for the shift of certain fees from the federal government to the state and that the agency intends to notify the Legislature and stakeholders in 2026 about proposed assessment changes for plan year 2027.

No formal vote occurred during the informational hearing. The presentation closed after lawmakers’ questions and committee members were told contract development and budget details will be refined in coming months.