Sources and plain meanings
The evidence behind the choices.
Primary authorities, the current research boundary and a short glossary. A source citation does not establish that a particular payment is available or approved.
Follow the question into the research.
Fifteen useful questions, with the supported point, remaining work and direct source paths kept together.
What has been screened—and what remains.
The review screens county and district funds; public-hospital transfers and certified expenditures; distinct Tribal mechanisms; behavioral-health service partnerships; GME; and other local, restricted and private support.
Additional screens cover cities and joint public bodies, lodging tax, public and private ambulance programs, ports, education-service partnerships, public assets and service purchases, administrative claiming, eligibility staff, independent philanthropy, CDBG, federal grants and credit, and existing assessment financing.
The remaining questions are specific: who owns available funds, what restrictions apply, what costs qualify, which payment route can be approved, and how much a hospital retains after offsets. A broad category screen is not proof of a committed contribution or a funded program.
Primary authorities.
Federal law and guidance
- Medicaid financing rules (42 CFR 433.51–433.68). Which public funds can serve as the non-federal share, and the limits on donations and provider taxes.
- CMS directed-payment guidance (February 2, 2026). The new Medicare-based limits and the 2028 step-down. The guidance calls itself preliminary.
- CMS proposed rule CMS-2449-P (May 22, 2026). A proposal, not a final rule.
- CMS provider-tax guidance (November 14, 2025). Restrictions on provider-tax changes.
- Direct graduate medical education payments (42 CFR 438.60). The exception for state plan education payments.
- CMS State Health Official letter #16-002 (2016). 100 percent federal match through Tribal care coordination.
- Rural Health Transformation (42 USC 1397ee). RHT funds cannot be used as the non-federal share.
Oregon law and plan
- ORS 442.470. Oregon's rural hospital categories.
- ORS 414.728, 414.598, 414.855 and 414.871. Cost-based payment for small rural hospitals, the CCO rules, and the hospital assessment.
- ORS 413.241. The return of enhanced Tribal match to Indian health care providers.
- ORS chapter 440. Health districts and port hospitals.
- ORS 451.010. Limits on county service districts.
- ORS 320.350 and Oregon Laws 2026, chapter 121. Lodging-tax allocation.
- Oregon Constitution, Article XI, section 9. Limits on local governments aiding private corporations.
- Oregon Medicaid state plan amendment 24-0025. Oregon's approved graduate medical education payments.
- SCR 209 (2026). Presession drafting and filing deadlines.
Program pages
- OHA, Rural Health Transformation Program. Current award status.
- OHA, ground emergency medical transportation programs. The public and private ambulance programs.
- OHA, opioid settlement funds. Allocation and permitted uses.
Supporting authorities for the drafting choices.
The returned LC 1969 draft, dated November 5, 2026, is the source for the current study language and dates; it is not a filed or introduced measure. The following authorities support the specific statutory questions in the requests:
- Oregon Revised Statutes § 413.241; Oregon Revised Statutes §§ 414.728, 414.855(3)(c)–(4); Oregon Revised Statutes § 442.470.
- Oregon Laws 2026, chapter 121, §§ 1–3, addressing lodging-tax allocations operative January 1, 2027.
- State of Oregon Subdivision Agreement Regarding Distribution and Use of Settlement Funds, § 4(c), pp. 3–4, addressing the covered opioid-settlement receipts.
- 42 C.F.R. § 438.60, Prohibition of additional payments, and Oregon Medicaid State Plan Amendment 24-0025, Attachment 4.19-A, pp. 13–16, approved July 9, 2025, informing the GME option; the proposal does not assume current eligibility or new receipts.
A short glossary.
- CCO (coordinated care organization).
- The regional plans that deliver most Oregon Health Plan services.
- Certified public expenditure (CPE).
- Eligible public spending certified to OHA so the state can claim federal matching funds. Any remittance to the certifying provider follows the applicable method.
- Critical access hospital.
- A federal designation for small rural hospitals, paid on a cost basis by Medicare.
- Directed payment.
- A state instruction governing how a Medicaid managed-care plan pays a provider class. Covered hospital arrangements face the federal total-payment limits explained on the money page; this is not a cap on every hospital receipt.
- Disproportionate share hospital (DSH) payment.
- A state-administered Medicaid payment for eligible hospitals serving many low-income patients, financed with federal and nonfederal shares and subject to its own eligibility, allotment and hospital-specific limits.
- Fee-for-service.
- Payment by OHA directly for each service, outside CCOs.
- Graduate medical education (GME).
- Payments for the costs of training resident physicians.
- Intergovernmental transfer (IGT).
- Public money one government transfers to another, here to OHA, for Medicaid.
- Non-federal share.
- The share not paid by federal Medicaid matching funds. The source must qualify; narrow federal statutes can allow specified federal-origin funds.
- Rural referral center; sole community hospital.
- Distinct Medicare hospital-payment classifications, each with its own eligibility rules.
- Type A, B and C hospitals.
- Oregon's rural hospital categories, defined mainly by bed count and, for the smaller types, distance to another hospital (ORS 442.470).
- Upper payment limit.
- A federal aggregate limit that generally tests base and supplemental fee-for-service hospital payments together within specified governmental or private hospital groups against a Medicare-payment estimate. DSH has separate limits.
- LC, LFO, LRO.
- Legislative Counsel, which drafts bills; the Legislative Fiscal Office, which analyzes spending; and the Legislative Revenue Office, which analyzes revenue.