Nurses Can Now Bill Medicaid Directly—Oregon Just Made History

Oregon Governor Tina Kotek signed House Bill 2789 into law on May 28, 2025. This landmark legislation allows registered nurses to bill Medicaid directly for care-management services, marking a substantial change in how nursing care is recognized and compensated in the state.

Set to take effect on January 1, 2026, this new law represents a fundamental shift in how nurses can operate within Oregon's Medicaid system. Previously, registered nurses were unable to independently bill Medicaid in most settings, requiring oversight or association with physicians or advanced practice providers to receive compensation for their services.

The new legislation changes this dynamic by directing the Oregon Health Authority and Coordinated Care Organizations (CCOs) to "contract directly with and develop payment methodologies" for nurses providing these services.

The change specifically targets care coordination services, a critical aspect of healthcare delivery that nurses have long provided but rarely been directly compensated for. By removing the supervision requirements, nurses can now bill Medicaid without physician oversight for these specific services, streamlining care delivery and potentially improving access for vulnerable populations.

For patients enrolled in Oregon's Medicaid program, this change could mean improved access to care coordination services. These services help patients navigate complex healthcare systems, manage chronic conditions, and access appropriate resources—all functions registered nurses are well-positioned to provide.

As the implementation date approaches, the Oregon Health Authority will develop specific guidelines for nurses wishing to participate in direct billing. Nurses will likely need to obtain a National Provider ID and enroll as Oregon Medicaid Providers, similar to requirements currently in place for other healthcare professionals.

Oregon's policy innovation may serve as a model for other states grappling with healthcare access issues and seeking to optimize their nursing workforce. By recognizing and compensating nurses directly for care coordination services, Oregon has taken a significant step toward acknowledging the full value and capability of registered nurses in today's healthcare system.

🤔 Nurses, share your thoughts in the discussion forum below.