The short answer? YES.
Oregon Health Plan (also known as OHP) has pretty great coverage for people who want addiction treatment.
The long answer? Still YES. However, there are some important things to keep in mind when you’re shopping for addiction treatment services that take OHP in Portland and beyond. This post will cover some of the good-to-know facts that will help you maximize your benefits and get the treatment you need.
What Addiction Treatment Services are Covered by OHP or Oregon Health Plan?
In short, most kinds of evidence-based addiction treatment services are covered by OHP. CareOregon offers a pretty good synopsis of the basics of medicaid addiction treatment coverage in Oregon. For a more in-depth look at member benefits, you can always refer to the OHP member handbook.
Briefly, OHP covers services like:
- One-on-one counseling
- Substance use disorder inpatient and outpatient programs
- Residential rehab
- Group counseling
- Psychotherapy
- Psychiatry
- Medical detox
- Services relating to co-occurring disorders
- MAT or medication assisted treatment (ie. Suboxone, Methadone, Vivitrol, etc)
- Veterans’ behavioral health – services specific to mental health and substance use issues experienced by veterans and their families
- Gambling addiction services
- Trauma-informed care and trauma-specific services for SUD patients who have a trauma history that may contribute to their substance use
- Peer support
- Culturally specific support services for BIPOC patients
Do I Need a Referral to Access Addiction Treatment Services or Rehab Through OHP?
In general, you don’t need a referral to access addiction treatment services with OHP in Portland or anywhere in Oregon.
Substance Use Disorder (SUD) services are considered “direct access” with OHP, meaning that you don’t need to seek a referral or get any kind of prior authorization from your Primary Care Physician (PCP) or any other entity before directly contacting the service provider you’d like to receive services from. There is no limit to the length of time you engage these services.
The same goes for Assertive Community Treatment and Wraparound Services, like those available at community health centers throughout Oregon, like OutsideIn in Portland. Those programs are also considered “direct access” and no referral of any kind is needed to access them. There is also no time limit to these services – you can access them for as long as needed.
Do I Need a Referral to Access Medication Assisted Treatment, MAT, Suboxone, Buprenorphine or Methadone on OHP?
Medication Assisted Treatment (MAT) operates a little differently from other addiction treatment services on OHP. According to the OHP handbook, a referral for MAT “may” be required in order to access addiction treatment medications. However, you can generally access MAT services for 30 days without prior approval. After 30 days, you’ll need to seek approval from your provider. Your MAT provider should be able to help you with this step when that time comes.
There is no time limit to these services outside of the special “introductory” 30 day period. You can access MAT services for as long as you need them with OHP.
Where Can I Enroll in Oregon Health Plan and/or Check My Coverage in Order to Access Addiction Treatment Services?
If you need to enroll in OHP in order to access SUD services, you can do so here. You can also check to see if you qualify for benefits at this site.
Oregon Health Plan is a Major Payer for Addiction Treatment Services Throughout the State
If you have OHP and you want addiction treatment services, you’re in good company. OHP is actually the largest payer for SUD treatment in the state. OHP covers addiction treatment for about 48,000 every year and spends well over $2 million dollars a year on addiction prevention and treatment in Oregon.
30% of OHP Members Recently Lost Their Coverage. Double-Check That You Still Have OHP Coverage for Addiction Treatment.
There were special federal rules for Medicaid coverage during COVID-19. During the pandemic, no one lost their OHP coverage because reviews were temporarily halted by this change in the federal rules. However, those rules stopped applying when the state of emergency officially ended.
In April 2023, OHP members began receiving redetermination letters requesting information about their income and other eligibility criteria to see if they still qualify for OHP. Most members were able to have their coverage renewed automatically, but some did receive these letters. If you received a letter, it is very important that you respond to it in order to maintain your OHP coverage. If you received a letter and did not reply, it’s possible that your OHP coverage has ended.
Some 30% of OHP members have lost their coverage in 2023 due to this rule change. Some are not aware that they lost their coverage. If you need addiction treatment services, it’s not a bad idea to check and see if you are still enrolled in OHP.
Looking for MAT, Buprenorphine for Addiction Treatment or Opioid Use Disorder Treatment in Portland Oregon?
At Shanti Recovery and Wellness, we understand how difficult it can be to seek treatment for SUD. We are committed to reducing barriers to treatment for addiction treatment patients in Portland, Oregon and beyond.
Interested to learn more about how we can help? Give us a call today to begin your journey to freedom from addiction.