Current through Register Vol. 63, No. 9, September 1, 2024
(1) In the OSIPM program:
(a) If an applicant requests and is eligible
for retroactive medical benefits, the earliest date the applicant may be
eligible is the first day of the third month before the month that includes the
date of request (see OAR
461-115-0030). For example, if
the applicant requests benefits on July 10th, eligibility may begin as early as
April 1.
(b) Except as provided for
in subsections (c) and (d) of this section, after the earliest date is
established, eligibility is determined on a month-by-month basis. The period
starts on the earliest established date and ends on the last day of the month
prior to the month that includes the date of request. For example, if the
applicant requests benefits on August 10th, the earliest date is May 1.
Eligibility is established separately for May 1 through May 31, June 1 through
June 30, and July 1 through July 31.
(c) Retroactive eligibility is not available
for any period that an individual is a resident of a public
institution (see OAR
461-135-0950) except for the
date of incarceration and the date of release, unless coverage would be
available under OAR 461-135-0950 while a
resident of a public institution.
(d) The earliest effective date of
retroactive eligibility for an individual who was receiving medical benefits in
another state during the retroactive period is the day following the date that
benefits end in the other state.
(2) If an applicant requests and is eligible
for retroactive QMB DW, the earliest date the applicant may be eligible is
three months before the date of request.
(3) If a QMB-SMB or QMB-SMF applicant
requests and is eligible for retroactive payment of Part B Medicare premiums,
the earliest date the applicant may be eligible is three months before the date
of request.
(4) If an applicant
applying for REFM is eligible for retroactive medical benefits, the earliest
the applicant may be eligible is the most recent of the following:
(a) The date the applicant arrived in the
United States; or
(b) Three months
before the date of request.
Statutory/Other Authority: ORS
409.050,
411.060 &
411.404
Statutes/Other Implemented: ORS
409.010,
411.060 &
411.404
