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Nearly 96,000 people are scheduled to move Feb. 1 from PacificSource to Trillium, but the Oregon Health Authority has not provided a recent update.
Essential background
The PacificSource-to-Trillium transition involves policy terms and timelines that can be confusing. Here are three basics to help:
- Medicaid coverage in Lane County is provided through the Oregon Health Plan, administered by the Oregon Health Authority, the state’s health agency. People in the plan are called members.
- The authority contracts with coordinated care organizations, or CCOs — typically insurance companies — which deliver members’ benefits through networks of health care providers.
- In Lane County, those CCOs are PacificSource Community Solutions and Trillium Community Health Plans, but PacificSource will no longer operate as a CCO after January 2026. PacificSource members will move to Trillium Feb. 1.
Oregon Medical Group has not yet reached an agreement with Trillium Community Health Plans, meaning Medicaid patients who receive care there may need to find new clinics or doctors.
Karrie Spitzer, a spokesperson for Optum — a national health care company and a division of UnitedHealth Group that owns Oregon Medical Group — sent Lookout Eugene-Springfield the following statement, which remained applicable to negotiations as of Jan. 21:
“Oregon Medical Group physicians and care teams are focused on ensuring patients can continue receiving care without disruption. We are actively working with Trillium to reach a Medicaid agreement that will allow patients to continue receiving high-quality care from the Oregon Medical Group clinicians they know and trust.”
Oregon Health Authority and Trillium have not released specific numbers showing progress in closing the gap for more than 15,000 people whose providers were not in Trillium’s network last month amid the Medicaid transition in Lane County.
Nearly 96,000 Lane County residents on Medicaid will be switched Feb. 1 from PacificSource to Trillium as their coordinated care organization.
In December, Lookout Eugene-Springfield confirmed that between 15,000 and 25,000 members have doctors or clinics that are not in Trillium’s network. About 10% of PacificSource members — 9,600 people — have primary care providers who are not part of Trillium’s network. Nearly 16% of PacificSource members — 15,360 people — have behavioral health providers who are not in the network.
It remains unclear how many of those patients receive care at Oregon Medical Group.
Since Jan. 7, Lookout Eugene-Springfield has repeatedly asked the Oregon Health Authority and Trillium for updates on efforts to close the network gaps. The authority has not responded to questions in the past two weeks.
Trillium said in a Jan. 12 statement that it was “making positive progress in our provider negotiations” and that “all PeaceHealth clinics are in-network with us.”
At a public meeting last month, executive leaders committed to finding care providers to expand coverage. For members who may have providers who are out-of-network, they pointed to a framework it calls “transition of care,” which allows members to continue seeing their current providers for 30, 60 or 90 days past the Feb.1 transition, depending on individual needs.
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