H.R. 1 is a federal law passed in 2025 that requires changes to Medicaid, known as OHP in Oregon. The changes will take effect at different times from late 2026 through 2028.

Most members will keep their OHP benefits, but some will face new eligibility rules, more frequent renewals, and changes to coverage. These rules may affect members who receive care from Advanced Health providers, including some adults enrolled in HOP.

Key H.R. 1 changes and their impact on providers

1. More frequent eligibility renewals

Expected late 2027

Many adults ages 19–64 in the affected Medicaid group will need to renew OHP every six months. Other members, including children, will generally renew yearly. This replaces the current two-year renewal cycle for many members.

Potential provider impact:

• More frequent changes in member eligibility and coverage status.
• More need to check eligibility before appointments and services.
• Possible gaps in coverage if members miss notices or do not complete renewals.
• More staff time spent helping members find renewal information and understand notices.

Recommended preparation: Review eligibility-check procedures, train front-desk staff, and remind members to keep their contact information current and respond to OHP notices.

1. New work or activity requirements

Beginning 2027

Some adults ages 19–64 will need to show that they meet work or activity rules when they apply for or renew OHP. They may qualify by earning enough income, attending school at least half-time, or completing at least 80 hours a month of approved work or other activities. Many members are exempt, including people who qualify under certain disability, pregnancy, caregiving, and other rules.

Potential provider impact:

• Some patients may need help understanding whether a medical condition qualifies them for an exemption.
• Providers may receive requests for medical records or statements to support an exemption.
• Patients who lose coverage could delay appointments, medications, or treatment.
• Staff may need to help patients find official information about the rules.

Recommended preparation: Establish a process for responding to appropriate requests for medical documentation. Keep records of diagnoses, treatment plans, and functional limitations when clinically relevant. Give patients accurate information about where to get eligibility help.

OHA states that members can report exemptions without providing proof in 2027. More exemptions will require proof in 2028, subject to further guidance. Providers should wait for official instructions before changing documentation practices.

1. Shorter coverage for past medical bills

January 1, 2027

OHP will cover a shorter period of past medical bills for people who newly enroll or reapply after losing coverage. Currently, eligible members may receive help with up to three months of past bills. Starting January 1, 2027, most adults ages 19–64 in the affected group will have up to one month covered; other eligible groups will generally have up to two months.

Potential provider impact:

• Less opportunity for payment of services provided before a patient’s coverage began.
• Greater risk that some older claims will not qualify for payment under the new rules.
• More importance placed on checking eligibility and documenting coverage dates.

Recommended preparation: Review registration, eligibility verification, billing, and claims follow-up procedures. When coverage is unclear, staff should check the applicable OHP rules rather than assume past services will be covered.

1. Fees for some health care services

October 2028

Some adults will be required to pay small copayments for certain services. OHA says these fees will not apply to some groups, including adults with Medicare or OHP based on disability, and members with annual incomes under $15,000. Checkups, emergency care, mental health care, prenatal care, substance use treatment, and care at community health clinics are among the services listed as exempt.

Potential provider impact:

• Changes to billing and patient communication for services subject to copayments.
• A need to identify which members and services are exempt.
• Additional questions from patients about costs and coverage.

Recommended preparation: Monitor OHA guidance before changing fee collection or billing workflows. The details may change as the state receives more federal direction.

3. How the HOP transition and H.R. 1 work together

The HOP transition and H.R. 1 changes may affect the same patient in different ways.

For example, an adult who currently receives HOP benefits through Advanced Health may move to OHP Open Card on January 1, 2027. That same member may also be subject to new work or activity rules or more frequent renewals, depending on their eligibility group and any exemptions.

This means providers should not assume that moving to Open Card automatically protects a member from all other OHP changes. Similarly, a member’s transition to Open Card does not automatically mean their benefits have ended.

Area	HOP transition	H.R. 1
Main change	Members move from CCO coverage to OHP Open Card	Federal eligibility and coverage rules change
Timing	January 1, 2027	Phased changes from late 2026 through 2028
Provider enrollment	OHP FFS enrollment is needed to serve HOP members through Open Card	Eligibility verification and documentation processes may need updates
Care coordination	CCO-based coordination and some optional services may no longer be available	Coverage changes may affect continuity of treatment
Billing	OHP FFS billing rules apply to Open Card services	Past-bill coverage and future copayment rules may affect payment

4. Recommended action plan for Advanced Health providers

The following steps can help practices prepare for the changes and reduce disruption to member care.

Provider readiness checklist

Confirm OHP FFS enrollment. Determine whether your practice and relevant clinicians are enrolled and able to bill OHP Open Card.

Review billing procedures. Prepare for OHP FFS claims, eligibility checks, and applicable authorization requirements.

Identify potentially affected members. Use appropriate available information to identify HOP members who may need help finding care after January 1, 2027.

Plan for continuity of care. Review ongoing treatment, referrals, medications, and upcoming visits for affected members.

Train front-desk and billing staff. Explain the difference between CCO coverage and Open Card, and review where staff can verify eligibility.

Prepare for documentation requests. Set a process for handling member requests for relevant medical records or statements that support exemptions.

Share trusted member resources. Direct members to OHA, OHP Open Card, and approved enrollment assistance resources rather than interpreting eligibility on their behalf.

Monitor official updates. Review OHA guidance regularly, especially as additional rules for 2027 and 2028 are released.

5. Provider resources and contacts

• OHA — H.R. 1 and OHP changes: Official federal changes webpage . Includes timelines, work or activity rules, renewal changes, and member information.
• OHP Open Card: OHPOpenCard.org . Helps members find providers who accept Open Card.
• OHP FFS provider enrollment: Oregon Health Plan provider information . Providers can also contact OHP provider enrollment at 800-336-6016, option 6, or email provider.enrollment@odhsoha.oregon.gov.
• OHP member eligibility and renewals: Members can call 800-699-9075 or visit Benefits.Oregon.gov .

6. Key takeaways

Advanced Health providers should focus on three priorities:

1. Prepare for the HOP transition. Confirm OHP FFS enrollment, billing readiness, and plans to maintain care for affected members.
2. Prepare for H.R. 1 operational changes. Review eligibility checks, renewal support, medical documentation processes, and billing practices.
3. Protect continuity of care. Help members understand where to get reliable information and plan ahead if their coverage or provider options change.

The dates and requirements above reflect OHA information available as of October 26, 2026. Some implementation details remain subject to further state and federal guidance. Providers should use current OHA rules and applicable OHP FFS billing guidance when making operational or clinical decisions.

• Key webpages:
  • All published partner materials: OHP Toolkit Homepage: Bookmark and check back regularly for updated resources for staff and partners supporting members.
  • Navigation page for SNAP / OHP overlap: H.R. 1 Information for ODHS and OHA Partners Homepage: Helps partners quickly find information and resources to help people on SNAP and OHP.  Bookmark and check back regularly for updated resources.
    • NEW Spanish SNAP / OHP navigation page:  Spanish version
• NEW Comprehensive policy FAQ for partners: English
• Talking points for member questions: English / Spanish
• HR1 Implementation Timeline: English
• Fact sheet for education partners: English
• HR1 CCO FAQ: English (Note: Will be updated as responses come in for outstanding questions)
• NEW Public Charge talking points: English
• NEW Social Media Cards: English / Spanish
• For Medicaid providers:
  • How will providers be affected by federal changes to OHP?: English
  • Patient conversation guide: English

• Key webpage: Federal Changes Homepage (direct link: OHP.Oregon.gov/HR1): Bookmark and check back regularly for updated resources
  • NEW Spanish Federal Changes Homepage: https://www.oregon.gov/oha/HSD/OHP/pages/federal-changes-es.aspx
• Key webpage: Work or Activity Rules if you get both SNAP and OHP: Bookmark and check back regularly for updated resources
• NEW Key webpage update: Public Charge (Spanish)

 

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