Or. Admin. Code § 410-200-0100
Current through Register Vol. 63, No. 11, November 1, 2024
Section 410-200-0100 - Coordinated Eligibility and Enrollment Process with the Department of Human Services and the Federally Facilitated Marketplace(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.Or. Admin. Code § 410-200-0100
DMAP 54-2013(Temp), f. & cert. ef. 10-1-13 thru 3-30-14; DMAP 4-2014(Temp), f. & cert. ef. 1-15-14 thru 3-30-14; DMAP 20-2014, f. & cert. ef. 3-28-14; DMAP 67-2014(Temp), f. 11-14-14, cert. ef. 11-15-14 thru 5-13-15; DMAP 3-2015, f. & cert. ef. 1/30/2015; DMAP 78-2015(Temp), f. & cert. ef. 12-22-15 thru 6-18-16; DMAP 24-2016, f. & cert. ef. 6/2/2016; DMAP 23-2020, amend filed 05/07/2020, effective 5/8/2020; DMAP 32-2022, minor correction filed 02/16/2022, effective 2/16/2022; DMAP 89-2023, amend filed 12/19/2023, effective 12/20/2023; DMAP 94-2024, amend filed 05/29/2024, effective 6/1/2024Statutory/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