Using your OHP

Your OHP ID card names your CCO (coordinated care organization). That is the local company that runs OHP where you live. Your plan decides which doctors and surgeons you can see, so this is the first thing to know.

• In Multnomah, Washington and Clackamas counties there are two CCOs: Health Share of Oregon and Trillium Tri-County.
• Inside Health Share, you also have a plan: CareOregon, OHSU Health, Kaiser Permanente or Providence. Each has its own doctors and hospitals.
• Providence's Health Share plan ends December 31, 2026. Members move to CareOregon on January 1, 2027, with nothing to do. Providence hospitals and clinics stay open.
• Not sure which CCO you have? Call OHP Client Services at 800-273-0557.

No card yet? You can still get care. Call OHP Client Services and ask for your member ID.

Open Card is OHP without a CCO. You can see any provider who bills the state directly. Search at ohpopencard.org, or call Care Coordination at 800-562-4620.

People usually have Open Card because they:

• have Medicare or other insurance first
• are American Indian or Alaska Native and chose it
• are in the last three months of pregnancy and want to keep their provider
• got approved by the state for a serious health reason

Starting January 1, 2027, Healthier Oregon members move to Open Card.

Your assigned primary care doctor is the door to specialists and some prescriptions. You can change who that is by calling the number on your ID card.

• CareOregon: Prism Health, Outside In, Quest Center, Bridge City Family Medical and Planned Parenthood all prescribe hormones. Legacy Gender Care Services is in network too.
• OHSU Health: OHSU clinics and the OHSU Transgender Health Program, 503-494-8311.
• Kaiser: Kaiser Permanente Northwest Gender Pathways Clinic, 503-249-6748.
• Trillium: use Find a Provider, or ask Member Services (877-600-5472) for a gender-affirming primary care doctor.

For the full path to hormones and providers, see Getting gender-affirming care.

OHP covers gender-affirming care for adults when it is medically necessary:

• Without surgery: hormones, labs, hair removal, voice therapy, mental health care
• Surgery: facial, chest, genital, gonadectomy and body contouring

Oregon law gives you three protections:

• A plan cannot deny this care by calling it "cosmetic."
• Any denial has to be reviewed by a provider with experience in gender-affirming care.
• The plan has to help you find care without long delays.

Surgery and hair removal usually need prior approval. Your provider asks for it, not you. Ask the surgeon's office how many letters they want. The current standard asks for one.

Planning surgery? See Recovering from gender-affirming surgery.

Hair removal waits are long. If surgery is in your plans, start electrolysis early.

OHP pays for rides to covered care. Book ahead.

• Health Share: Ride to Care, 503-416-3955
• Trillium: MTM, 877-583-1552

You can switch to reach a doctor or surgeon. A switch takes effect on the 1st of the next month.

• Between plans inside Health Share: call Health Share at 503-416-8090. Your benefits stay the same.
• Between Health Share and Trillium: call OHP Client Services at 800-273-0557, or use your ONE account.

Before you switch:

• Confirm the doctor or surgeon is in the new plan's network.
• Ask what happens to any approval that is already in progress.

• No provider, or a long wait: call your plan and say that Oregon law (ORS 414.769) requires them to help you find gender-affirming care. Ask what they will do and by when.
• A denial: ask for it in writing, and ask your provider to appeal.
• Still stuck: call the OHA Ombuds Program at 877-642-0450. They are on your side, and it is free.

A "no" from a plan is often the start of the process, and plenty of denials get overturned.