Or. Admin. R. 410-200-0436

Current through Register Vol. 63, No. 5, May 1, 2024

Section 410-200-0436 - Specific Requirements: MAGI Expanded Adult Program

(1) The Modified Adjusted Gross Income (MAGI) Expanded Adult program is effective April 1, 2023.

(2) Individuals who lose eligibility for other OHP Plus medical benefits due to an increase of countable income may be eligible for the MAGI Expanded Adult program if they:

(a) Are 19 years of age or older and under age 65;

(b) Have household income greater than 138 percent federal poverty level through 200 percent federal poverty level (OAR 410-200-0315) for the applicable family size;

(c) Meet citizenship or non-citizen status requirements outlined in OAR 410-200-0215;

(d) Are not entitled to or enrolled in Medicare benefits under part A or B of Title XVIII of the Act; and

(e) Are not receiving SSI benefits.

(3) As a condition of MAGI Expanded Adult program eligibility for parents or caretaker relatives with a dependent child living in the home, the child must be enrolled in minimum essential coverage.

(4) The MAGI Expanded Adult program is not available to new applicants or individuals reapplying after a break in coverage.

(5) The MAGI Expanded Adult program is not subject to protected eligibility provisions related to pregnancy, described in OAR 410-200-0135 - Assumed, Continuous, and Protected Eligibility for Children and Pregnant Individuals section (3).

(6) The MAGI Expanded Adult program eligibility is not subject to the pursuit of assets requirements found in OAR 410-200-0220 - Requirement to Pursue Assets.

Or. Admin. R. 410-200-0436

DMAP 11-2023, adopt filed 03/30/2023, effective 4/1/2023

Statutory/Other Authority: 42 CFR 435.110, ORS 435.112, 435.115, 435.116, 435.118, 435.403, 435.940, 435.1200, 457.80, 457.340, 458.350, 435.3, 435.4, 435.406, 435.407, 435.952, 435.956, 435.1008, 457.320, 457.380, 435.608, 433.138, 433.145, 433.146, 433.147, 433.148, 435.117, 435.119, 435.1205, 435.170, 435.190, 435.222, 435.610, 435.916, 435.917, 447.56, 457.350, 457.360, 457.805, ORS 411.402, 411.404, 413.042 & 414.534

Statutes/Other Implemented: ORS 411.402, 411.404, ORS 411.060, 411.095, 411.400, 411.406, 411.439, 411.443, 413.032, 413.038, 414.025, 414.231, 414.440, 414.534, 414.536 & 414.706