Oregon Administrative Rules
Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS
Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS
Section 410-200-0100 - Coordinated Eligibility and Enrollment Process with the Department of Human Services and the Federally Facilitated Marketplace

Universal Citation: OR Admin Rules 410-200-0100

Current through Register Vol. 63, No. 9, September 1, 2024

(1) This rule describes the coordination of eligibility and enrollment between the Oregon Health Authority (Authority), the Oregon Department of Human Services (Department), and the FFM. The Agency shall:

(a) Minimize the burden on individuals seeking to obtain or renew eligibility or to appeal a determination of eligibility for insurance affordability programs;

(b) Ensure determinations of eligibility and enrollment in the appropriate program without undue delay, consistent with timeliness standards described in OAR 410-200-0110 based on the application date;

(c) Provide coordinated content for those household members whose eligibility status is not yet determined; and

(d) Screen every applicant or beneficiary who submits an application, renewal, or reports a change requiring redetermination of eligibility for criteria that identify individuals for whom MAGI and MAGI-based income methods do not apply.

(2) For individuals undergoing eligibility determinations for HSD Medical Programs, the Agency, consistent with the timeliness standards described in OAR 410-200-0110, shall:

(a) Determine eligibility for MAGI Medicaid/CHIP on the basis of having household income at or below the applicable MAGI-based standard; or

(b) If ineligible under section (2)(a), direct those individuals as appropriate to the FFM.

(3) The Agency shall, consistent with the timeliness standards described in OAR 410-200-0110, Screen for eligibility for non-MAGI programs as indicated by information provided on the application or renewal form.

(4) For HSD Medical Program beneficiaries who become ineligible for ongoing HSD Medical Program benefits, if an evaluation for non-MAGI programs is indicated by information provided in the case record, the Agency shall maintain HSD Medical Program benefits while eligibility for non-MAGI programs is being determined, and shall not take action to close benefits until determination of eligibility is complete.

(5) Coordination among agencies:

(a) The Agency shall maintain a secure electronic interface through which the Authority can send and receive an individual's electronic account from the FFM;

(b) The Agency may not request information or documentation from the individual included in the individual's electronic account or provided for the sake of other Agency benefits; and

(c) If information is available through electronic data match and is useful and related to eligibility for HSD Medical Programs, the Agency shall obtain the information through electronic data match.

Statutory/Other Authority: ORS 411.402, 411.404, 413.042 & 414.534

Statutes/Other Implemented: ORS 411.400, 411.402, 411.404, 411.406, 411.439, 411.443, 413.032, 413.038, 414.025, 414.231, 411.447, 414.534, 414.536 & 414.706

Disclaimer: These regulations may not be the most recent version. Oregon may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.