Starting in October, Oregon’s largest Medicaid provider, CareOregon, will no longer cover therapy sessions with out-of-network providers.
Previously, licensed mental health care providers could see clients with the state’s Medicaid plan and bill CareOregon and its local partners.
According to CareOregon, the change will affect about 15,000 clients, which is roughly 15% of its members who use behavioral health services.
Kalia Feldman-Klein, a licensed therapist in private practice in Jackson County, said about one-third of her clients will be affected. She said she’s referring them to providers in CareOregon’s network but worries the transition won’t be easy.
“It can take a while to find a therapist that’s the right fit,” Feldman-Klein said. “Especially if you’re in the middle of treating like complex trauma, to suddenly have to stop that treatment and find someone else is a big disruption.”
In a statement, CareOregon described the move as a return to a pre-pandemic policy, although Feldman-Klein said the organization worked with out-of-network therapists as recently as 2019, when she opened her practice.
CareOregon said rising costs and federal cuts to Medicaid are behind the decision.
“Services from non-contracted providers cost as much as 40%-95% more than from contracted providers,” the non-profit insurance provider said in a statement.
Feldman-Klein said she and other providers were notified last week about the changes.
“The suddenness of how it's being rolled out is really surprising and concerning,” she said.
In August 2024, CareOregon stopped covering therapy from graduates still completing the 1,900 supervised hours needed for a license if they work in private practice. That change means recent graduates must work for an agency or clinic to see Medicaid patients.
