PacificSource Health Plans, an insurance provider based in Springfield, plans to stop serving Oregon Health Plan (OHP) members in Lane County on Jan. 1, 2026. PacificSource’s 90,000 members in the Lane County service area can expect to see their insurance service transition to another Coordinated Care Organization (CCO).
The process to get another CCO in Lane County is ongoing as the Oregon Health Authority seeks organizations capable of managing the members PacificSource will no longer serve starting next year.
Here’s what to know about the state of PacificSource in Lane County and the future of local OHP coverage.
What’s happening to PacificSource in Lane County?
The Oregon Health Authority (OHA) is responsible for increasing access to health care statewide. OHA administers the OHP, which provides health care coverage to low-income Oregonians.
Residents who qualify for OHP currently have a choice of two insurance providers in Lane County: PacificSource Health Plans and Trillium Community Health Plans.
These insurance providers act as Coordinated Care Organizations (CCO), managing a network of providers who deliver care to Medicare and other OHP recipients.
PacificSource notified OHA Sept. 18 it would not renew its Lane County CCO contract. This leaves Trillium to absorb some of the patients losing coverage through PacificSource and means OHA may need to find another CCO to help serve the more than 90,000 people that PacificSource currently covers in Lane County.
More: What are your Medicaid alternatives in Lane County if PacificSource leaves?
Is PacificSource pulling out of Lane County?
Yes. PacificSource plans to end its CCO contract Jan. 1.
PacificSource also has decided to exit Health Share of Oregon as of Jan. 1. Health Share of Oregon is a nonprofit serving Oregon Health Plan members in Clackamas, Multnomah and Washington counties by bringing together health plans, providers and community health resources to help members access care.
Why is PacificSource leaving Lane County as a Medicaid provider?
OHA sets reimbursement rates for its CCOs each year that encourage plans to operate to their overall budget.
Willamette Week reported that CCOs in the state saw their expenses increase by 10% between 2023 and 2024, while the state’s per-member payment increased by just 3.4%.
In August, OHA proposed a 6.8% per-member rate increase for 2026. After further negotiations, OHA offered to increase the reimbursement rate by 10.2% for 2026. Despite these changes, PacificSource did not renew its CCO contract in Lane County.
The change in PacificSource coverage in Lane County, initially reported by The Lund Report, stems from financial losses the insurance provider is incurring.
In an emailed statement to The Register-Guard, Erin Fair Taylor, vice president of Medicaid programs for PacificSource, said PacificSource and OHA “were unable to arrive at a solution” after months of conversations.
PacificSource Health Plans, based in Springfield, will no longer be an Oregon Health Plan CCO option for Lane County residents in 2026.
Fair Taylor said PacificSource knows this decision affects many Oregonians.
“Unfortunately, after extensive discussions, it became clear that continuing participation under current terms would undermine our ability to effectively serve the people who rely on us and put the long-term sustainability of our organization at risk,” Fair Taylor said.
More: Lane County’s Medicaid insurance providers are changing. What to know about Trillium
OHA responds to PacificSource’s exit from Lane County
Kristen Lambert, communications officer for OHA, said over the course of negotiations for CCO contracts, “PacificSource requested an increase beyond what the state could pay for and that exceeded statutory requirements.”
Lambert said the state is obligated to keep networks strong and sustainable while protecting taxpayer dollars.
“This year’s negotiations have been especially difficult due to a number of factors, including federal uncertainty and rising health care costs, not just here in Oregon but across the nation,” Lambert said.
What happens to PacificSource patients in Lane County?
Lambert said the current contract means “PacificSource is required to provide services,” while OHA locates another provider.
“There is a process for ensuring that members maintain CCO coverage and we will be working through those steps in the coming months. As part of the current contract, PacificSource is required to provide services while OHA completes the process of locating another network provider.
“There will be no immediate changes to benefits for providers, community members, or OHP members,” Lambert said. “OHA will be working closely with PacificSource, as with all of our CCOs, to ensure continuity of care for members in Lane County.”
Jason Davis, public information officer for Lane County Health & Human Services, said as of August, there were 21,946 PacificSource and 8,226 Trillium Community Health Plan members assigned to the county’s clinics.
He said the county is “awaiting information from OHA on next steps for individuals covered by PacificSource.”
Davis said PacificSource patients at Lane County’s clinics would see no immediate changes, as “everyone who currently receives Medicaid coverage will continue to be on Medicaid and have access to benefits.”
What other insurance options do PacificSource patients have?
Tigard-based Trillium Community Health Plan is the only other Oregon Health Plan insurance provider in Lane County. Courtney Johnston, senior director for government relations and communications for Trillium, said in an email that Trillium currently serves 36,035 OHP members in its Lane County service area, which also includes western Douglas County and parts of Linn County.
She said Trillium intends to continue serving Lane County as a Coordinated Care Organization and is working to preserve care for its members in Lane County. Trillium is addressing the possibility of an increase in local patients seeking insurance.
Davis said if Trillium needs time to accommodate more members by building a larger network or if Trillium doesn’t wish to take on those patients, OHA could seek alternatives. He said Lane County would await direction from OHA on what those solutions may be.
OHA representatives did not respond to additional questions from The Register-Guard by deadline.
Davis said the likely solution is that Trillium would accept “all of those covered lives with their current provider networks.” By law, Medicaid patients must be assigned to a Coordinated Care Organization.
Do PeaceHealth hospitals accept Trillium?
PeaceHealth accepts all forms of Medicaid, said Communications Manager Jim Murez.
Jim Murez, communications manager for PeaceHealth, said PeaceHealth accepts patients who are insured by PacificSource or Trillium and the hospital is monitoring the situation.
“If PacificSource does leave the Lane County market, PeaceHealth accepts all forms of Medicaid and will continue to do so,” Murez said. “Additionally, PeaceHealth has always provided care for all regardless of their ability to pay and will continue to do so.”
Does McKenzie-Willamette Medical Center accept Trillium?
Jana Waterman, vice president of business development and marketing for McKenzie-Willamette Medical Center, said the hospital is in network for PacificSource. She said MWMC does not accept Trillium as a form of insurance.
Johnston, Trillium’s spokesperson, said while Trillium does not currently have a contract with MWMC, the hospital won’t deny care in an emergency regardless of a person’s insurance coverage.
“It is a hospital facility so all members can be seen for emergency services,” Johnston said. “Hospitals are subject to federal EMTALA (Emergency Medical Treatment and Labor Act) laws that require them to see everyone who comes through their doors for emergency services.”
Hannarose McGuinness is The Register-Guard’s growth and development reporter. You can reach her at [email protected].
This article originally appeared on Register-Guard: What you need to know about PacificSource leaving Lane County
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