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Oregon officials lay out HR1 implementation timeline and warn of large administrative and coverage impacts
Summary
OHA told lawmakers HR1 would impose Medicaid work requirements and other eligibility changes affecting about 700,000 people in the expansion group, with implementation steps (including redeterminations and copayments) and potential administrative strain; the agency emphasized exemptions and federal guidance needs.
Oregon Health Authority staff told the House Interim Committee on Healthcare that federal legislation known as HR1 will require substantial changes to state Medicaid operations and could lead to large numbers of disenrollments if not implemented carefully. "There are about 700,000 folks in Oregon in the Medicaid expansion eligibility group," agency staff told the committee when outlining who would be affected.
OHA explained the core requirement: beginning Dec. 31, 2026 (the agency’s assumed implementation date), adults in the expansion group will generally need to document either 80 hours of work per month or qualifying community engagements (job search, community service, training) or qualify under detailed exemptions. Staff listed exempt groups: American Indian and Alaska Native members of federally recognized tribes, pregnant or postpartum individuals, people meeting SNAP/TANF work exemptions, students, those in substance‑use‑disorder treatment, veterans with disabilities, former foster youth, and people deemed medically frail. Presenters cautioned that identifying some exemptions (for example, recent enrollment in treatment or new diagnoses) depends on claims and partner data that can lag, creating implementation complexity.
Presenters described other HR1 provisions with operational consequences: more frequent redeterminations for expansion adults (every six months rather than every two years), new home equity limits for long‑term services, reduced windows for retroactive coverage, and a requirement that some expansion enrollees face copayments. OHA staff also said the law blocks marketplace coverage for people who lose Medicaid solely because of the work requirement, which could leave some without any insurance option.
OHA summarized implementation planning: the agency established interagency incident management teams, published recommended guidance, issued Medicaid contract amendments to protect coverage, and is coordinating communications and navigator support. They noted substantial IT changes, staffing needs for eligibility work, and potential appeals and administrative burdens for members who lose coverage erroneously. The agency also flagged a statutory deadline: CMS final rules are due in June 2026 under HR1, which would give states about six months to implement operational details.
Committee members pressed staff on practical questions—how tipped or seasonal income would count toward hours, how new disability diagnoses would be protected, and whether waiver options exist to delay some provisions. OHA answered that much depends on upcoming federal guidance and that the agency is seeking clarifications and drafting potential statutory fixes for the 2026 short session.
Public and provider witnesses testifying later in the hearing warned HR1 could cause tens or hundreds of thousands to lose coverage, increase uncompensated care, and exacerbate workforce shortages. Providers urged legislative and administrative steps to preserve access, expand navigators and outreach, and protect vulnerable populations.
