OHA details Medicaid budget drivers, school billing work and multi-year timeline for child behavioral-health changes

Oregon Health Authority officials briefed the Joint Subcommittee on Human Services on Feb. 3 about Medicaid budget drivers, implementation of the Section 1115 waiver and a package of policy option proposals intended to shore up services and federal funding.

The presentation identified caseload growth and changes to federal matching rules as the primary budget drivers, highlighted declining tobacco-tax revenue used for Medicaid, and flagged two expiring financing mechanisms — a hospital assessment due to lapse Oct. 1, 2025, and an insurer assessment that expires in December 2026 — as risks to the state share of Oregon Health Plan financing.

Why it matters: Medicaid accounts for the largest single program share in the governor’s budget; financing changes, caseload swings and federal policy shifts could materially affect what services the state can sustain and when new services come online.

Dr. Sejal Hathi, Oregon Health Authority director, said the “stability and care-expansion portions of the 1115 waiver really focus on two main things: eligibility and enrollment, and expanded services for people.” She described several specific program changes the waiver supports, including continuous enrollment rules to reduce churn, expansion of early and periodic screening, diagnostic and treatment services (EPSDT) for children, the new Young Adults with Special Health Care Needs (WiSHEN) benefit, and newly launched housing and nutrition benefits under the health-related social needs program.

Hathi and Emma Sando, Medicaid director, told the panel the waiver and related authorities are intended to reduce interruptions in care caused by administrative redeterminations and to increase access to services that address social drivers of health. Hathi said the housing benefit launched in November and a…