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@OHAOregon
October 17, 2024
Media contact: Franny White, Franny.l.white@oha.oregon.gov, 971.349.3539
SALEM, Ore. – Oregon Health Authority (OHA) will pay 3.1.% more per month in 2025 for coordinated care organizations (CCOs) to provide Medicaid benefits to eligible Oregonians. As a result, OHA will pay an average of $529.89 per-member-per-month next year for CCOs to coordinate the medical, dental and behavioral health care services for most of the state’s Medicaid enrollees.
“CCO rates provide reliable funding that ensures eligible Oregonians can continue to access quality, comprehensive health care through Medicaid,” said OHA Director Sejal Hathi, M.D., M.B.A. “This funding anchors the important care coordination that CCOs provide as pandemic-era supports end and more people use health care services.”
In Oregon, Medicaid provides health coverage to about 1.4 million people, including low-income adults, children, pregnant women, elderly adults and people with disabilities, regardless of their immigration status. Medicaid is administered by states according to federal requirements, and the program is jointly funded by states and the federal government.
OHA contracts with CCOs to coordinate health care for those who receive insurance through the Oregon Health Plan (OHP), the state’s Medicaid program. CCOs coordinate care for the vast majority of OHP members, or about 1.3 million people.
The per-member-per-month payments that OHA pays CCOs, also called CCO capitation rates, are updated annually based on CCO financial data. OHA developed 2025 capitation rates after analyzing CCO financial performance for 2023, the last year for which full financial data is available.
The state’s 16 CCOs collectively had a 2.2% consolidated operating margin in 2023, taking in a total of $173 million net operating income that year, according to a brief that OHA released this summer. While most CCOs had a net profit in 2023, four operated at a loss.
New, preliminary analysis also suggests that CCOs may experience lower profit margins this year. OHA analysts have calculated that Oregon CCOs collectively had a 1.3% consolidated operating margin through June 30, 2024, taking in a total of $50 million net operating income. Five CCOs reported having an operating loss during the first half of 2024 as part of the risk-based contracts. Full analysis of 2024 CCO financial performance will be released in 2025.
Recent CCO operating margins may have peaked at 4.6% in 2022, when fewer people accessed routine health care services due to the COVID-19 pandemic. Still, the apparent 2022 peak was comparatively lower than the highest-recorded 7.5% operating margin that CCOs collectively experienced in 2014, when the Affordable Care Act expanded Medicaid eligibility.
Other key CCO financial performance data from 2023 include:
The 2025 CCO capitation rates reflect new initiatives that will roll out in the coming months, including:
While OHA normally aims to increase CCO capitation rates 3.4% annually, the 2025 rate increase has been set at 3.1% due to state funding constraints. OHA will continue to monitor CCO access to care data and measures to ensure members are able to receive timely, high-quality care.
Oregon Revised Statute 414.593 requires that CCO expenditures be made fully transparent and available to the public. Financial statements for all 16 CCOs can be found here.