If your child gets occupational therapy through the Oregon Health Plan, or your family relies on a prosthetic limb, a wheelchair seating evaluation, or an ABA program, those services now appear by name on a state document about where Oregon might spend less money.

Nothing has been cut. No bill has passed. What happened is that a panel Gov. Tina Kotek convened to find savings finished its work and handed her a list, and the services disability families depend on are on it.

What the Advisory Group Delivered

Oregon faces an estimated $421 million general fund gap in its 2027-29 Medicaid budget, according to reporting by OPB published July 8 and updated July 9. The gap traces to H.R.1, the federal law that made the deepest reductions to Medicaid since the program began. Oregon also projects roughly $2.5 billion in lost federal matching funds as enrollment drops under new work requirements and more frequent eligibility checks.

Kotek asked an 18-member advisory group to find a way through with the least harm. The group met privately every two weeks for six months. It did not reach consensus, and it did not rank anything. Instead it produced more than 40 separate options for reducing spending and left the choosing to the governor and the legislature.

"Ultimately, the governor and the legislature are going to have very difficult choices to make," former Oregon Health Authority director Bruce Goldberg told OPB. Kotek's own assessment was shorter: "We shouldn't be in this situation."

Her budget proposal is due to the legislature in December.

The Services Named on the List

Federal law requires state Medicaid programs to cover certain services. Everything else is classified as optional, which is a budgeting term, not a description of how much a family needs it.

The optional benefits Oregon could eliminate outright include adult dental care, physical therapy and occupational therapy, behavioral health case management, prosthetics, and acupuncture and chiropractic care. Dropping adult dental alone would save close to $88 million over the biennium, though advisory group members raised concerns that people would simply arrive in emergency rooms with dental infections instead.

Other options narrow services rather than ending them. Capping the number of talk therapy visits per year would save about $12 million. Adding utilization review to applied behavior analysis for autism would save roughly $9 million, which in practice means more prior authorization paperwork standing between a child and an approved hour of therapy. Consolidating the prescription drug list would save about $24.3 million and would reach diabetes medications and immune-modulating drugs. Visit limits applied across benefits generate only about $55 million against a $421 million target, which is why the elimination options remain on the table at all.

The Oregon Health Plan covers 1.4 million people, roughly one in three Oregonians and more than half the children in the state.

The Coverage Losses Are a Separate Problem

The benefit cuts under discussion sit on top of eligibility changes already scheduled. Oregon expects about 200,000 people to lose coverage as work requirements and six-month redeterminations take hold, and the budget hole is projected to reach $868 million by 2029 as federal support phases down further.

Families in other states have watched a version of this arrive already. Georgia's Medicaid plans cut therapy payment rates by 20%, and providers left the network rather than absorb the loss. CMS has separately proposed new limits on the payments that fund disability home care, with a comment period of its own.

What Oregon Families Can Do Before December

The five months between now and Kotek's budget proposal are the part of this process where an individual family's voice carries weight. Once a benefit is written out of a budget document, restoring it becomes a much harder argument.

The Oregon Health Policy Board holds public meetings with time reserved for public comment, and its agendas and materials are posted at oregon.gov/oha/OHPB. A parent describing what happens to a child who loses weekly OT is telling the board something the advisory group's spreadsheet cannot.

State legislators will vote on whatever Kotek proposes. Calling or writing your own senator and representative now, before a bill number exists, means the conversation starts with your family's situation rather than with a line item.

Documentation matters more once utilization review arrives. If your child receives ABA, PT, or OT, ask the provider for current evaluations, progress notes, and a written statement of medical necessity, and keep copies. If a prosthetic or orthotic replacement is coming in the next two years, ask the prescribing clinician whether it can be scheduled sooner. Families who have been through an insurance appeal know the file gets built before the denial, not after, and therapy grant programs exist for the gap year when coverage and need do not line up.

The advisory group spent six months and would not name which service should go first. Kotek and 90 legislators will have to, and they will do it between now and December.