Budget Explorer/CCO Capitation/Service Spending

$26.5B BreakdownDental Spotlight

Where CCOs Spend Their Money

Oregon's 15 CCOs receive $26.5B in capitation — but where does it actually go? Hospital stays, prescriptions, dental care, behavioral health? This page breaks down CCO spending by service category, reveals which CCOs invest more in dental and behavioral health, and exposes the pharmacy cost surge reshaping Medicaid budgets.

Hospital / Facility

$9.5B

36% of all CCO spend

Pharmacy

$4.0B

Fastest growing — GLP-1s, biologics

Dental

$1.8B

7.0% of total — wide CCO variation

Behavioral Health

$2.4B

MH + SUD — growing demand post-M110

Where the $26.5B Goes

Statewide CCO spending by service category. Hospital/facility is the largest single category. Area proportional to spend.

Spending Proportions by CCO

100% stacked view — shows how each CCO allocates its budget across services. Hover a category in the legend to isolate it.

Health Share

38%

21%

15%

Trillium

38%

21%

15%

PS Central OR

35%

22%

16%

PS Marion/Polk

36%

21%

16%

Eastern OR

34%

21%

16%

AllCare

36%

21%

15%

Jackson Care

35%

22%

15%

10%

InterCommunity

35%

21%

15%

10%

PS Lane

35%

21%

16%

10%

Columbia Pacific

33%

21%

15%

10%

Yamhill

35%

21%

15%

10%

Umpqua

35%

21%

16%

10%

Advanced

35%

21%

15%

10%

Cascade

35%

20%

16%

10%

PS Gorge

32%

21%

16%

11%

Spending Mix by CCO

Stacked bars show each CCO's total biennial spend broken down by service. Hospital dominates everywhere, but proportions vary.

Dental Spending Spotlight

$1.8B total

Dental averages 7.0% of CCO spend statewide. But the range is wide — some CCOs invest significantly more in oral health than others. This matters for provider reimbursement and access.

Dental as % of Total CCO Spend

Dental PMPM & Total Spend

PS Gorge

$58/mo$25M total

Umpqua

$72/mo$55M total

PS Central OR

$64/mo$130M total

Cascade

$72/mo$38M total

Columbia Pacific

$75/mo$68M total

Jackson Care

$68/mo$90M total

PS Lane

$69/mo$75M total

InterCommunity

$68/mo$82M total

Yamhill

$62/mo$52M total

AllCare

$69/mo$100M total

PS Marion/Polk

$64/mo$120M total

Advanced

$65/mo$42M total

Trillium

$68/mo$195M total

Health Share

$63/mo$650M total

Eastern OR

$61/mo$95M total

Pharmacy: The Fastest-Growing Category

$4.0B

GLP-1 drugs (Ozempic, Wegovy), specialty biologics, and gene therapies are driving pharmacy spend growth of 12-18% annually. Some CCOs now spend more on pharmacy than professional services.

Cascade

16.0%

$152/mo

PS Gorge

16.0%

$111/mo

PS Central OR

15.9%

$132/mo

Umpqua

15.7%

$143/mo

Eastern OR

15.7%

$151/mo

PS Marion/Polk

15.6%

$142/mo

PS Lane

15.5%

$144/mo

InterCommunity

15.5%

$142/mo

Yamhill

15.4%

$129/mo

Jackson Care

15.4%

$140/mo

Trillium

15.4%

$149/mo

AllCare

15.4%

$149/mo

Advanced

15.3%

$142/mo

Health Share

15.0%

$145/mo

Columbia Pacific

15.0%

$148/mo

Portland metro vs the vast rural east vs Klamath — three different Oregons.

Spending Profile Comparison

Radar chart comparing spending mix (% of total) across selected CCOs. Different shapes = different priorities.

Key Findings

Hospital dominates — but varies by CCO. Statewide, hospital/facility costs eat 36% of CCO budgets. But rural CCOs like Eastern Oregon spend proportionally more on transport (NEMT) and less on hospital, reflecting the distance-to-care reality. Urban CCOs face higher facility rates from concentrated hospital systems with pricing power.

Dental investment is uneven. Dental ranges from ~5% to ~8% of total CCO spend depending on the organization. This gap directly affects provider reimbursement rates and patient access. CCOs that allocate more to dental generally have stronger dental networks and shorter wait times. For dental practices, knowing which CCOs invest in oral health drives contracting decisions.

Pharmacy is the pressure point. At $4.0B statewide, pharmacy is now the third-largest spending category and growing 12-18% annually. GLP-1 drugs alone could add $200-400M in costs if coverage expands to obesity. CCOs with higher pharmacy spend are squeezing other categories — watch for dental and BH to get crowded out.

Behavioral health: spending doesn't match the crisis. Despite Oregon's acute behavioral health emergency, BH averages only ~9% of CCO spend. The Governor's $330M+ BH investment is designed to supplement — not replace — CCO behavioral health spending. The question: are CCOs investing enough of their own capitation in BH, or relying on state supplemental funds?

NEMT reveals the rural-urban divide. Non-emergency medical transport (NEMT) is a small line item statewide, but for Eastern Oregon CCO — covering 12 counties larger than some states — transport costs run 5-6% of total spend, double the urban average. Members driving 100+ miles to a specialist is a budget reality, not an edge case.

Statewide Summary

Service Category	Biennial Total	% of Total	Annual Per Member	Trend
Hospital / Facility	$9.5B	36.4%	$4,095	Stable — 2-3% growth
Professional Services	$5.5B	21.1%	$2,369	Moderate — 3-4% growth
Pharmacy	$4.0B	15.3%	$1,723	Surging — 12-18% growth
Dental	$1.8B	7.0%	$783	Flat — 1-2% growth
Behavioral Health	$2.4B	9.1%	$1,021	Growing — 6-8% growth
Transport (NEMT)	$0.8B	3.1%	$348	Stable — tied to fuel costs
Admin & Quality Pools	$1.3B	5.2%	$580	Flat — regulatory pressure to cut
Other / Reserves	$0.8B	2.9%	$331	Variable
Total	$26.1B	100%	$11,250

Sources & Methodology

Service-level spending estimated from OHA CCO Financial Reports (quarterly financial statements)
National Medicaid managed care benchmarks from MACPAC MACStats Data Book
Pharmacy trend data from KFF Medicaid Spending Analysis

Service-category breakdowns are estimates based on CCO financial filings, OHA aggregate data, and national Medicaid benchmarks. Individual CCO allocations vary quarterly based on utilization patterns, contract renegotiations, and population health changes. Official program-level data is published in OHA's Medicaid Management Information System (MMIS). Pharmacy figures do not include 340B savings or manufacturer rebates.

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For informational purposes only. Spending estimates are derived from publicly available financial reports and may not reflect final audited figures. Does not constitute financial, legal, or policy advice. Built by Oregon Intel — Praxis AI.