More than one in four Washington County residents are on Medicaid, and a $1.3 billion state funding gap could put that coverage at risk.

State health officials told the Oregon Senate Health Care Committee on Wednesday, Sept. 9, that the 2025 federal tax and spending law will force Oregon to find $421 million in the 2027–29 budget cycle and $868 million in the 2029–31 cycle to keep its Medicaid system intact, the Oregon Capital Chronicle reported.

Researchers at Princeton University estimate about 200,000 Oregonians will lose coverage through 2031 as the law takes effect. In Washington County, 27.6% of residents are enrolled in the Oregon Health Plan (OHP), the state's Medicaid program, according to OHA data compiled by the Oregon Office of Rural Health. Statewide, more than 1.4 million people are on OHP.

Fariborz Pakseresht, interim director of the Oregon Health Authority (OHA), was blunt with lawmakers.

"I also need to be very candid with you … Even with our best work, there are going to be people who lose coverage," Pakseresht said.

What's changing

The federal law cut roughly $1 trillion from Medicaid nationwide over the next decade, state officials told the committee. It imposed new work requirements and more frequent eligibility reviews that states must now administer.

OHA anticipates notifying 600,000 Oregonians by late September about requirements to prove they complete 80 hours per month of work, volunteering or education. The mandate applies to adults ages 19 to 64. Parents or caregivers of children under 14 are exempt, as are people with medical conditions that severely limit their ability to work.

By the end of 2027, most OHP enrollees will face eligibility reviews every six months instead of every two years. Vivian Levy, OHA's Medicaid deputy director, told lawmakers the process will become "more difficult and cumbersome."

Earlier in 2026, state officials allocated about $110 million to the Oregon Department of Human Services (ODHS) to hire additional eligibility review staff. OHA said it is also upgrading technology so enrollees can upload payroll documents for faster verification.

Immigrants shifted to state-funded program

The federal law also stripped Medicaid eligibility from immigrants with certain legal statuses, including refugees, asylees and survivors of domestic violence or human trafficking. By October, about 7,000 people in those categories will move to Oregon's Healthier Oregon program, which uses state funds to cover low-income residents regardless of immigration status.

Oregon is the only state offering such a program without restrictions on coverage or enrollment, according to the Kaiser Family Foundation.

Lawmakers signal concern but no plan

Legislators gave little indication at the Sept. 9 hearing of how they would fill the budget gaps. State Sen. Deb Patterson, a Salem Democrat who chairs the committee, pushed back after Levy reported that U.S. Department of Health and Human Services officials have cast doubt on states' ability to obtain a waiver delaying the work requirements.

Gov. Tina Kotek has convened an Advisory Group on Medicaid Sustainability that identified the $421 million figure as the general fund target for the 2027–29 biennium. The group estimated total federal funding impacts at $9.4 billion through 2031.

OHA's late-September notification letters to 600,000 enrollees will be the next visible step for local residents.