Oregon Administrative Rules
Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS
Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS
Section 410-200-0521 - Unwinding Period - HSD Medical Programs

Universal Citation: OR Admin Rules 410-200-0521

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

(1) The provisions in this rule apply to all Health Systems Division (HSD) Medical Program determinations effective April 1, 2023, and later. Notwithstanding any other rule to the contrary in these chapter 410 division 200 rules, during the unwinding period, HSD Medical Program eligibility shall be determined as set forth in this rule.

(2) For the purposes of this rule, the term "unwinding period" refers to the period of 15 calendar months beginning April 1, 2023, in which the agency will initiate a full eligibility renewal for all HSD Medical Program beneficiaries.

(3) In accordance with the Consolidated Appropriations Act, 2023, the continuous enrollment conditions established via the Families First Coronavirus Response Act end effective March 31, 2023.

(4) Except for individuals receiving coverage during a period of presumptive eligibility (see OAR 410-200-0105), individuals who were receiving HSD Medical Program benefits prior to April 1, 2023, shall maintain coverage as described in OAR 410-200-0520 until their unwinding period renewal activity is initiated.

(5) Individuals receiving coverage during a period of presumptive eligibility shall maintain presumptive eligibility coverage until:

(a) A full eligibility determination is completed; or

(b) The individual's benefits are terminated due to failure to complete the full application process.

(6) The Agency shall determine eligibility based on self-attestation of financial eligibility information and will request necessary verification (see OAR 410-200-0230 - Verification) via post-eligibility Request for Information (RFI).

(7) Information about RFIs during the unwinding period:

(a) The Agency will provide 90-days to respond to RFIs;

(b) Failure to respond to a post-eligibility RFI will result in termination of benefits in accordance with section (8) of this rule, with the following exceptions:
(A) For individuals age 18 years and younger, failure to respond to a post-eligibility RFI for income verification will not result in termination of benefits; eligibility will be maintained through the 12-month Continuous Eligibility period (see OAR 410-200-0135) or the end of the month in which they turn 19 years of age, whichever is earlier;

(B) For pregnant individuals, failure to respond to a post-eligibility RFI for income verification will not result in termination of benefits; eligibility will be maintained through the duration of pregnancy and the postpartum eligibility period (see OAR 410-200-0135).

(8) Recipients who are determined ineligible for ongoing HSD Medical Benefits will be provided 60-day advance notice of termination or reduction of coverage and referred to the Federally Facilitated Marketplace as described in OAR 410-200-0100, if applicable.

Statutory/Other Authority: ORS 411.402

Statutes/Other Implemented: ORS 411.402

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