Trillium commits to close gap for thousands of incoming members who have out-of-network providers

Essential background

The PacificSource-to-Trillium transition involves policy terms and timelines that can be confusing. Here are three basics to help:

1. 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.
2. The authority contracts with coordinated care organizations, or CCOs — typically insurance companies — which deliver members’ benefits through networks of health care providers.
3. 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.

For nearly 96,000 Lane County residents on Medicaid who will move from PacificSource to Trillium in the new year, Oregon Health Plan benefits will remain the same, Oregon Health Authority representatives said during a listening session, Thursday, Dec. 11.

Some members, however, may need to change heath care providers once the transition takes effect Feb. 1.

As of Thursday, 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…

Story continues