Medicaid 2026: What Oregon Therapists Must Know About the New QDP Rules

The Rules Are Changing. Are You Ready?

Effective January 1, 2026, the Oregon Health Authority is overhauling Qualified Directed Payments (QDPs) — the mechanism that determines enhanced Medicaid reimbursement rates for behavioral health providers. These changes will reshape the economics of therapy practice for thousands of Oregon clinicians. (CareOregon)

What's Changing

• Team-based care required for enhanced rates — You must offer coordinated, integrated care for OHP members with complex behavioral health needs to qualify for enhanced QDP rates
• 50% revenue threshold — At least 50% of your annual behavioral health revenue must come from Medicaid services
• Certification required — Must be a Community Mental Health Program (CMHP) or hold OHA Certificate of Approval
• 90% DMAP rates for non-qualifiers — Providers who don't meet the above criteria will receive 90% of standard Oregon Medicaid rates

What OHP Actually Pays

The reality of OHP reimbursement rates often surprises providers — in both directions. Current licensed provider rates are competitive:

• Individual therapy (53-minute session): ~$185
• Couples/family therapy: ~$205
• Intake/diagnostic assessments: Higher rates apply

You credential through your regional Coordinated Care Organization (CCO), not OHA directly. Oregon's 16 CCOs include Health Share/CareOregon (Portland metro), Trillium (Lane County), PacificSource (Central Oregon), AllCare (Southern Oregon), and others.

Recent disruption: The transition of Lane County from PacificSource to Trillium Community Health Plan required providers to re-credential — a process that disrupted continuity of care for thousands of OHP members in the Eugene area.

Impact on Solo Practitioners

The new QDP rules effectively push Oregon's Medicaid behavioral health system toward group practice and agency models. Independent therapists face difficult choices:

• Join or form a group practice that meets certification requirements and the 50% revenue threshold
• Diversify your payer mix to reduce Medicaid dependency (and accept the trade-off of potentially serving fewer low-income clients)
• Accept the 90% rate and adjust your practice economics

The Associate Therapist Problem

A 2025 policy change backed by Governor Kotek prohibits newly graduated associate therapists from independently billing OHP while in private practice (The Lund Report). Associates must work under a credentialed agency to bill Medicaid. According to Street Roots, this has reduced the pool of providers available to low-income Oregonians at a time when the state can least afford it.

What's Next

The 2025–2027 biennium budget includes over $100 million in new behavioral health investments, and the Governor's Behavioral Health Talent Council is working on a comprehensive workforce plan. Providers should monitor:

• CCO rate changes and credentialing deadlines
• OHA Certificate of Approval requirements
• Whether the 50% threshold is adjusted based on provider feedback

Sources

• CareOregon — QDP Behavioral Health Updates
• The Lund Report — Associate Billing
• Street Roots — OHP Access Changes
• OHA — Oregon Health Plan
• Trillium Community Health Plan