CareOregon Policy Changes (Updated 08/2025)
A lot has been changing following the policy
enacted by CareOregon in December.
Background on the Policy Changes
On Dec 5th 2024, CareOregon/Oregon Health Plan announced a policy revision that would strip access for all CareOregon members from working with Associate-level clinicians in private practice. This policy came to maturity on July 31st. 2025.
Then, on July 31st, CareOregon released another update indicating their intent to strip all fully-licensed Clinicians of this access as well. This will come to maturity on October 1st, 2025.
Maintaining Access
Because of these policies, Present Beings has transitioned to a cash-only practice. mI will continue to see CareOregon clients through my partner organization, Dian’s Well Counseling.
As of August 12, 2025: My OHP Caseload is full and I maintain a waitlist at Dian’s Well Counseling.
If you are an OHP CareOregon member looking for an individual therapist, I recommend you use this spreadsheet to see Group Practices who have the credentials to continue billing/providing services to OHP members. This referral sheet is not an endorsement of any particular practice, but a summation of data that has been shared with me to date.
Conjoint Treatment (Couples & Families) at DWC
Image description: two fat queerdos talk in bed over a cup of tea. They are engaged in eye contact and both have a slight smile.
After conferring with the owner of the group practice about this, I've been given the very unfortunate news that I will not be able to bill OHP clients for conjoint treatment, either in the short or long term. Below is an excerpt of the instructions I received:
"The long of the short of it is, we can't provide them on-going family therapy. [...] The main concern is that billing for marriage or couples counseling is considered fraud, waste, and abuse under Medicaid guidelines. Medicaid doesn’t expect to see billing for couples therapy for adults, [and] we can't provide long-term family therapy unless it's kids or adolescents. The only exception is for SUDs clinics, which is why some clinicians working for SUDs teams or agencies are so convinced all therapists are covered for it. While all other group practice owners warm vehemently against it."
As the above indicates, each clinic is going to have its own idea of what's allowed, but my work with the group practice requires I follow the strictest adherence to the CareOregon policy. Other clinicians who are not bound by COA-standards may still be offering these slots until the July cut-off date (when all Associate-level clinicians in Private Practice will stop being able to bill CareOregon independently).
I realize this is disappointing news for many of us, and I hope this blog post gives you some context to empower your decision making in next steps.
Wishing you well in the next steps of your journey!
- Ernest
