Or. Admin. Code § 410-200-0140

Current through Register Vol. 63, No. 11, November 1, 2024

Section 410-200-0140 - Eligibility for Residents of a Public Institution

(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.

Or. Admin. Code § 410-200-0140

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 25-2018, amend filed 05/01/2018, effective 5/1/2018; DMAP 23-2020, amend filed 05/07/2020, effective 5/8/2020; DMAP 33-2020, temporary amend filed 06/29/2020, effective 7/6/2020 through 1/1/2021; DMAP 67-2020, amend filed 12/22/2020, effective 1/1/2021; DMAP 12-2023, amend filed 03/30/2023, effective 4/1/2023; DMAP 94-2024, amend filed 05/29/2024, effective 6/1/2024

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