Oregon Administrative Rules
Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS
Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS
Section 410-200-0140 - Eligibility for Residents of a Public Institution

Universal Citation: OR Admin Rules 410-200-0140

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

(1) A resident of a public institution is not eligible for Health System Division (HSD) Medical Program benefits, except as follows:

(a) For individuals residing in an Institution for Mental Disease (IMD), including the Oregon State Hospital, who are:
(A) Under age 21;

(B) Age 21 if they were admitted to the IMD before their 21st birthday; or

(C) Age 65 or older.

(b) Residents of a public institution may be eligible for OHP Bridge - Basic Health Program benefits if they are awaiting disposition of charges.

(2) For all individuals enrolled in HSD Medical Programs except for OHP Bridge - Basic Health Program who become a resident of a public institution, benefits shall be suspended for the duration of the period in which the individual is a resident of that institution.

(a) The effective date of the suspension of benefits is the day following the date on which an individual becomes a resident of a public institution.

(b) Suspended benefits shall be reinstated effective the date on which an individual ceases to be a resident of a public institution without the need for a new application when:
(A) The Agency learns the individual is no longer a resident of a public institution within the twelve (12) calendar months following the date on which the change occurred; or

(B) The individual leaves the public institution to be admitted to a medical facility as an inpatient with an expected stay of at least 24 hours, provided the medical facility is not associated with the public institution where the individual is a resident.

(c) Once benefits are reinstated as described in subsection (2)(b) of this rule, a redetermination of eligibility shall be processed unless benefits are restored on a case where the existing renewal date is more than two (2) calendar months beyond the month in which the action is being taken.

(3) For individuals enrolled in OHP Bridge - Basic Health Program who become a resident of a public institution, benefits shall be terminated effective the day following the day on which they became a resident of a public institution except that coverage shall be maintained while the individual's charges are pending disposition. In order to regain eligibility for OHP Bridge-Basic Health Program following release from the public institution, the individual must reapply.

Statutory/Other Authority: ORS 411.095, 411.402, 411.404, 413.038, 414.025 & 414.534

Statutes/Other Implemented: ORS 411.070, 411.404, 411.439, 411.443, 411.445, 411.816, 412.014, 412.049 & 414.426

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.
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