Or. Admin. Code § 410-200-0440

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

Section 410-200-0440 - Specific Requirements; Extended Medical Assistance

(1) Individuals who lose eligibility for MAGI PCR due to the receipt or increase of earned income are eligible for a period of up to 12 months of Extended Medical Assistance if:

(a) They were eligible for and receiving MAGI PCR benefits for any one of the six months preceding the receipt or increase in earned income that resulted in loss of MAGI PCR eligibility;

(b) Eligibility is redetermined and the individual is found ineligible for any Medicaid program except BCCTP or Substitute Care; and

(c) They are the parent or caretaker relative of a dependent child living in their home.

(2) Individuals who lose eligibility for MAGI PCR due to the receipt or increase of spousal support are eligible for a period of up to four months of EXT if:

(a) They were eligible for and receiving MAGI PCR benefits for any three of the six months preceding the receipt or increase in spousal support that resulted in loss of MAGI PCR eligibility;

(b) Eligibility is redetermined and the individual is found ineligible for any Medicaid program except BCCTP or Substitute Care; and

(c) They are the parent or caretaker relative of a dependent child living in their home.

(3) The dependent children of individuals described in sections (1) and (2) are eligible for EXT for the same time period as their parent or caretaker relative if:

(a) They lost Medicaid eligibility due to the parent or caretaker relative's receipt or increase of earned income or spousal support; and

(b) Eligibility is redetermined and they are not eligible for any Medicaid program.

(4) The EXT eligibility period is established as described in sections (1) and (2) of this rule, beginning the first of the month following the month in which the beneficiary experienced the receipt or increase in earned income or spousal support resulting in loss of MAGI PCR eligibility. For individuals who receive other Medicaid/CHIP benefits during the EXT eligibility period:

(a) Such months are not an overpayment;

(b) Any month in which an individual receives other Medicaid/CHIP benefits when they were eligible for EXT is counted as a month of the EXT eligibility period.

(5) Individuals described in sections (1) through (3) of this rule who lose EXT eligibility for one of the following reasons may regain EXT eligibility for the remainder of the original EXT eligibility period if:

(a) EXT eligibility was lost because the individual left the household during the EXT eligibility period. The individual may regain EXT eligibility if they return to the household; or

(b) EXT eligibility was lost due to a change in circumstance that resulted in eligibility for another Medicaid program, and then a subsequent change in circumstance occurred that resulted in loss of eligibility for all Medicaid Programs.

(6) Individuals who lose eligibility for MAGI PCR and would be eligible to receive EXT except that they are determined eligible for another Medicaid program, and their dependent children, shall receive EXT benefits for the remainder of their original EXT eligibility period if:

(a) They subsequently lose eligibility for all Medicaid programs; and

(b) They continue to meet the non-financial eligibility requirements of MAGI PCR.

Or. Admin. Code § 410-200-0440

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 53-2015, f. 9-22-15, cert. ef. 9/25/2015; 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

Statutory/Other Authority: ORS 411.095, 411.402, 411.404, 413.038 & 414.025

Statutes/Other Implemented: ORS 411.095, 411.400, 411.402, 411.404, 411.406, 411.439, 411.443, 413.032, 413.038, 414.025, 414.231, 411.447 & 414.706