What’s Next for Oregon’s Coordinated Care Model? December 4, 2025 When Oregon transformed its Medicaid program in 2012 by adopting Coordinated Care Organizations (CCOs) statewide, the idea was simple: local control for local communities. IHN-CCO is one of these organizations dedicated to making healthcare more affordable, easier to access and more accountable to the people we serve. Because each region has different needs, CCOs can make decisions that best serve their members, with input from local hospitals, clinics and other community-based partners. Leaders from across the state recently gathered at the 2025 Oregon State of Reform Conference to talk about the future of this system. With major federal Medicaid cuts expected, they discussed what challenges lie ahead and how Oregon can keep its coordinated care model strong. A System Under Pressure Rep. Travis Nelson (D-Portland), a registered nurse and vice chair of the House Interim Healthcare Committee, said Oregon faces serious financial challenges in the coming years. However, Nelson said the government’s top goal should be ensuring its citizens are safe and healthy. “When we want to spend money on things as a nation, we find money for it,” he said. “We need to find money for the people. We have to put people first, whether it’s the federal government or state government.” Rep. Ed Diehl (R-Stayton), who also serves as vice chair on the House Healthcare Committee, said the Oregon Health Plan (OHP) was already struggling before Congress passed H.R. 1 earlier this year. That bill could cost the Oregon Health Authority up to $11.7 billion by 2031, according to estimates, and as many as 200,000 people may lose coverage due to new work requirements to remain enrolled. Diehl said lawmakers must find ways to “right-size” Medicaid going forward, which may include cutting costs for providers or taking a closer look at which services the state can afford to cover. Given the state of the economy, Diehl said he is not willing to consider raising revenue or lowering reimbursement rates as a solution. Budget Decisions & Other Key Issues Andi Easton, government relations director for IHN-CCO, said Oregon legislators are facing budget shortfalls. When it comes to Medicaid funding, they have just three levers they can adjust: What they pay providers for delivery of care. Which benefits are covered. Who is covered. How the state will pay for Medicaid gets more complicated with the passage of H.R. 1 and is now the biggest challenge on the horizon, Easton said. She added that retaining local control remains essential to the success of CCOs. Easton highlighted two additional priorities: Preserving the Prioritized List of Health Services. Maintaining funding under the Quality Incentive Program. The Prioritized List helps Oregon decide which treatments are covered based on medical evidence and cost-effectiveness. Local control also allows CCOs to make the most of a limited budget as it negotiates with local providers. The Oregon Health Authority has indicated it will phase out the list starting in 2027. Easton warned that eliminating the list will shift tough decisions to lawmakers. “It puts them in a greater accountability position that they may not want to be in,” she said. The Quality Incentives Program, meanwhile, is an important tool that provides additional payments to incentivize meeting certain health metrics, Easton said. It also helps to retain providers, especially in underserved communities. The Road Ahead Oregon’s CCO model has helped millions of residents to access health care over the past decade. But with major federal cuts ahead and debates about how to manage costs, policymakers and healthcare leaders are preparing for significant shifts. Even so, those at the conference said their focus remains on finding ways to protect access to care and maintain the community-driven approach that has defined Oregon’s system from the beginning. Paul Phillips, president of Pac/West Communications and an advocate for CCOs, cautioned leaders not to panic. Instead, he encouraged them to view the recent federal actions as an opportunity for breaking down barriers in the system. Having community-based CCOs making local decisions provides greater health outcomes and flexibility to do what’s best for the long-term of Oregon, Phillips said. “Oregonians should be very proud of what we’ve accomplished in changing the (health) delivery system,” he said. “Together, we can continue to be successful.”
