Frequently Asked Questions

What is Yamhill Community Care?

Yamhill Community Care is a Coordinated Care Organization (CCO) that serves Oregon Health Plan (OHP) members in Yamhill County, and parts of Clackamas, Washington, Marion, Polk and Tillamook counties.

A CCO is a network of all types of health care providers (physical health care, addictions and mental health care and dental care providers) who work together in their local communities to serve people who receive health care coverage under the Oregon health Plan (Medicaid). CCOs focus on prevention and helping people manage chronic conditions, like diabetes. This helps recue unnecessary emergency room visits and gives people support to be healthy.

What if I want to leave my CCO or change to a different one?

  • You can change plan during the first 30 days after you enroll.
  • If you are new to OHP, you can change CCOs during the first 90 days after you enroll.
  • If you move to a place that your CCO doesn’t serve, you can change CCOs as soon as you tell OHP Customer Service about the move.
  • You can change CCOs when you renew your OHP coverage. This usually happens cone each year.
  • You can change CCOs if you have an important OHP-approved medical reason.
  • To change to the same CCO that your primary care provider is in, talk to your primary care provider. The provider will work with OHA to help you change to the other CCO.
  • To change CCOs for any other reason or to leave your CCO, call Client Services at 1-800-273-0557.
  • If you have Private health insurance: you do not need to be in a CCO. Your insurance will manage your health care. Report your insurance at http://www.ReportTPL.org

If you are in a CCO but want to receive services as a Fee For Service member:
OHP want you to get managed health care from a CCO. CCOs are designed to make sure you receive the best possible care within your community. CCO’s can provide and cover some services that OHP cannot. But you can change to Fee-for-service (FFS) OHP at any time if:

  • You are an American Indian or Alaska Native
  • You are also on Medicare in addition to OHP or
  • You have an important medical reason that OHP approves

As of April 1, 2019 the Dual-Eligible members will be auto enrolled into the CCO an will have to ask for FFS if they want to top out. Dual-Eligible is individuals who are on Medicare and eligible for Medicaid.

How is Yamhill Community Care different than a traditional health plan?

Yamhill Community Care provides a different way of delivering care to OHP members. By working within the community, Yamhill CCO:

  • Integrates physical, mental and dental health services
  • Brings new models of care that are patient‐centered and team‐focused
  • Is local enough to be relevant and large enough to be financially sustainable
  • Is locally governed by a partnership among local health care providers and community members
  • Has a Community Advisory Council (CAC) that helps look at the community’s health care needs and recommends transformative changes

How can members contact Yamhill Community Care?

Members can call Yamhill CCO Customer Service toll-free at 1‐855‐722‐8205. TTY/TDD callers can dial 1‐800‐735‐2900 or 7-1-1.

For questions to the state about CCOs, members can call 1‐855‐226‐6170 or go to
www.oregon.gov/OHA/healthplan.

Who are Yamhill Community Care’s partners?

Yamhill Community Care works closely with the following organizations in the community:

  • Willamette Valley Medical Center
  • Physician’s Medical Center
  • Providence Newberg Medical Center
  • Yamhill County Health & Human Services
  • Virginia Garcia Memorial Health Center
  • Lutheran Community Services NW
  • Providence Medical Group
  • McMinnville Physicians Organization
  • Capitol Dental Care
  • Other local physicians and health providers

How does Yamhill Community Care gather input from the community?

Yamhill Community Care has a Community Advisory Council (CAC), which is made up of members, health care providers, representatives from the community, and representatives from county government. The job of the CAC is to ensure that the health care needs of the community are being addressed.

How do I report suspected Fraud, Waste and Abuse?

Yamhill Community Care takes fraud, waste and abuse very seriously. If you suspect that your benefits aren’t being used correctly or want to report a case of waste abuse or fraud, please contact the confidential hotline at 866-329-2309.