Or. Admin. Code § 410-200-0437

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

Section 410-200-0437 - Specific Requirements: OHP Bridge - Basic Medicaid

In addition to the general eligibility requirements applicable to OHP Bridge - Basic Medicaid as set out in OAR Chapter 410, Division 200, this rule describes specific eligibility requirements for OHP Bridge - Basic Medicaid.

(1) OHP Bridge - Basic Medicaid is effective on July 1, 2024.

(2) To be eligible for OHP Bridge - Basic Medicaid an individual must:

(a) Be age 19 or older and under age 65;

(b) Have, as required under OAR 410-200-0315, monthly MAGI-based household income greater than 133 percent of the federal poverty level (FPL) up to and including 200 percent federal poverty level for the applicable family size;

(c) Meet citizenship requirements outlined in OAR 410-200-0215 (1) or non-citizen status requirements outlined in OAR 410-200-0215 (4);

(d) Be exempt from mandatory enrollment in a non-Indian Managed Care Entity based on American Indian or Alaska Native status as is specified in section 1932 (2)(C) of the Social Security Act and its implementing federal regulation, 42 CFR 438.50 (d)(2).

(3) Even if an individual meets the requirements in section (2) above of this rule, the individual shall not be eligible for OHP Bridge - Basic Medicaid if they:

(a) Are enrolled in Medicare benefits under part A or B of Title XVIII of the Act; or

(b) Are receiving other healthcare coverage that qualifies as Minimum Essential Coverage as defined in OAR 410-200-0015 (55), unless that coverage is an Insurance Affordability Program as defined in OAR 410-200-0015 (50); or

(c) Be able to access affordable coverage as described in section 36B(c)(2)(C)(i)(II) and § 1.36B-2(c)(3)(v)(A)( 1) of the IRS Code. The required contribution percentage is indexed annually under section 36B(c)(2)(C)(iv); or

(d) Are receiving Supplemental Security Income (SSI) benefits.

Or. Admin. Code § 410-200-0437

DMAP 94-2024, adopt filed 05/29/2024, effective 6/1/2024

Statutory/Other Authority: ORS 411.402, 411.404, 413.042, 414.241, 414.534, 42 CFR 433.138, 433.145-433.148, 435.3-435.4, 435.110, 435.115-435.119, 435.170, 435.190, 435.222, 435.403, 435.406-435.407, 435.608, 435.610, 435.916-435.917, 435.940, 435.952, 435.956, 435.1008, 435.1200, 435.1205, 447.56, 457.80, 457.320, 457.340, 457.350, 457.360, 457.380, 457.805, 458.350 & 435.112

Statutes/Other Implemented: ORS 411.402, 411.404, 414.534, ORS 411.060, 411.095, 411.400, 411.406, 411.439, 411.443, 413.032, 413.038, 414.025, 414.231, 414.241, 414.440, 414.534, 414.536 & 414.706