CCO Capitation Payments
Oregon pays 15 Coordinated Care Organizations $26.5 billion this biennium to manage healthcare for ~1.2 million OHP members — one in three Oregonians. About 200K OHP enrollees remain in Fee-for-Service Medicaid (dual-eligibles, Healthier Oregon, open card). CCOs receive a fixed per-member-per-month rate covering medical, dental, behavioral health, and pharmacy. This page shows where that money goes, which CCOs get the most, and how rates vary across the state.
Where CCOs Spend Their Money →Service-level breakdown with dental spotlightOregon CCO Service Areas
36 counties · 15 CCOs · hover to exploreEnrollment vs. PMPM Rate
Larger CCOs tend to have moderate rates. Smaller rural CCOs command premium rates due to access costs.
Total Biennial Capitation by CCO
Estimated total payments (medical + dental + pharmacy + supplemental), 2025-27 biennium.
Medical Capitation Rate (PMPM)
Per-member-per-month rate, CY2025. Weighted average: $538. Range: $488-$614 (26% spread).
OHP Enrollment by CCO
~1.2M OHP members enrolled in CCOs (of 1.4M total OHP). ~200K remain in Fee-for-Service. Health Share alone serves ~36% of CCO enrollees.
Key Findings
All 15 CCOs
Health Share of Oregon
Trillium Community Health Plan
PacificSource - Central Oregon
PacificSource - Marion Polk
Eastern Oregon CCO
AllCare Health Plan
Jackson Care Connect
InterCommunity Health Plans
PacificSource - Lane
Columbia Pacific CCO
Yamhill Community Care
Umpqua Health Alliance
Advanced Health
Cascade Health Alliance
PacificSource - Columbia Gorge
How CCO Rates Are Set
OHA sets each CCO's capitation rate through an actuarial process that accounts for:
- Historical claims experience — what care actually cost for that CCO's population in prior years
- Acuity mix — age, disability status, and chronic conditions of the enrolled population
- Geographic cost factors — provider reimbursement levels, network adequacy, and rural access costs
- Trend factors — projected medical cost inflation, new drug launches, utilization changes
- Quality incentive pool — a portion withheld and earned back based on OHA quality metrics performance
The CY2025 rate increase of 3.4% was a compromise — CCOs requested 5%+ citing pharmacy cost growth and post-COVID utilization rebound, while OHA balanced fiscal constraints. The result: medical PMPM ranges from $488 (PacificSource Gorge) to $614 (Cascade), reflecting genuine cost variation across Oregon's diverse geography.
Sources & Methodology
- CCO capitation rates from OLIS CCO Capitation Rate Presentation
- Total CCO budget from LFO 2025-27 Budget Highlights
- CCO membership and financial data from OHA CCO Financial Reports
- FMAP rates from KFF FMAP Data
Enrollment figures and biennial payment estimates are derived from publicly available OHA rate-setting presentations, CCO financial reports, and LFO budget documents. Medical PMPM reflects the base medical capitation rate; total payments per CCO include dental, pharmacy, behavioral health, quality pools, and supplemental payments. Individual CCO biennial totals are estimates — official figures are published in OHA's Medicaid Management Information System.
For informational purposes only. Budget figures are drawn from publicly available legislative documents and may be subject to revision through supplemental budgets, emergency boards, or federal funding changes. Does not constitute financial, legal, or policy advice. Built by Oregon Intel — Praxis AI.