Oregon Administrative Rules
Chapter 461 - DEPARTMENT OF HUMAN SERVICES, SELF-SUFFICIENCY PROGRAMS
Division 135 - SPECIFIC PROGRAM REQUIREMENTS
Section 461-135-0875 - Specific Requirements; Retroactive Eligibility

Universal Citation: OR Admin Rules 461-135-0875

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

(1) Individuals are evaluated for retroactive eligibility as follows:

(a) In the OSIPM programs, when individuals received Medicaid-covered medical services prior to the date of request (see OAR 461-115-0030). This includes deceased individuals who would have been eligible for Medicaid covered services had they, or someone acting on their behalf, applied.

(b) In the QMB-DW program, when individuals paid or incurred Medicaid-covered Medicare Part A premiums, or were eligible for but not enrolled in Medicare Part A prior to the date of request and received Medicare Part A-covered services. This includes deceased individuals who would have been eligible for Medicaid-covered premiums had they, or someone acting on their behalf, applied.

(c) In the QMB-SMB and QMB-SMF programs, when individuals paid or incurred Medicaid-covered Medicare Part B premiums, or were eligible for but not enrolled in Medicare Part B prior to the date of request and received Medicare Part B-covered services. This includes deceased individuals who would have been eligible for Medicaid-covered premiums had they, or someone acting on their behalf, applied.

(d) Individuals applying for medical assistance through the REFM program are evaluated for retroactive eligibility.

(2) If eligible for medical assistance retroactively, the eligibility of the individual may not start earlier than the date indicated by OAR 461-180-0140.

(3) In the QMB-BAS program, there are no retroactive medical benefits.

Statutory/Other Authority: ORS 409.050, 411.060, 411.404, 413.085 & 414.685

Statutes/Other Implemented: 411.060, 411.404, 413.085, 414.685 & ORS 409.010

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