Or. Admin. Code § 410-200-0520

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

Section 410-200-0520 - COVID-19 Emergency Policies

The provisions in this rule apply to all Health Systems Division (HSD) Medical Program eligibility determinations made as of March 18, 2020 through March 31, 2023.

(1) In accordance with the Families First Coronavirus Response Act (FFCRA) and OAR 410-120-0011, following the declaration of a national public health emergency (PHE), the Authority adopts temporary measures related to HSD Medical program eligibility.

(2) In accordance with the Consolidated Appropriations Act, 2023, the continuous enrollment provisions established as part of the FFCRA are no longer coupled with the national public health emergency effective March 31, 2023. See OAR 410-200-0521 for Agency policies effective April 1, 2023.

(3) Notwithstanding any other rule to the contrary in these Chapter 410, division 200 rules, during the COVID-19 PHE, HSD Medical program eligibility shall be determined as set forth in this rule.

(4) Except for individuals receiving coverage during a period of presumptive eligibility (see section 5 of this rule), individuals who were receiving HSD Medical Program benefits on March 18, 2020, or who begin receiving coverage following that date via full eligibility determination shall not have benefits terminated prior to April 1, 2023, with the following exceptions:

(a) Terminations of coverage shall be limited to the following reasons:

(A) Eligibility was approved for an HSD medical program at either initial application or during a redetermination, and it is later determined the decision was incorrect due to one of the following:

(i) Administrative error; or

(ii) When a court determines the individual made a false or misleading statement, or misrepresented, concealed, or withheld a fact for the purpose of establishing or maintaining eligibility.

(B) The recipient dies;

(C) The recipient or someone authorized to act on their behalf requests voluntary termination of coverage; or

(D) The recipient is confirmed to no longer be a resident of Oregon.

(b) Coverage will be suspended for individuals who become incarcerated (see OAR 410-200-0140).

(5) Individuals receiving coverage during a period of presumptive eligibility are not subject to the provisions described in section (4) of this rule, as a full eligibility determination has not been made.

(6) Community Partners (see OAR 410-200-0015(27)) are granted authority to perform Presumptive Eligibility determinations pursuant to the policies outlined for Hospital Presumptive Eligibility in OAR 410-200-0105 for the duration of the PHE.

(7) The agency shall accept self-attestation of all eligibility criteria necessary to determine eligibility with the following exception:

(a) In the event that an individual's attestation of US citizenship, US national, or non-citizen status cannot be verified via FDSH or electronic verification sources available to the agency, the individual shall be provided a reasonable opportunity period (see OAR 410-200-0015(66)) to provide verification of their attestation;

(b) For individuals who are provided a reasonable opportunity period through March 31, 2023, the reasonable opportunity period has been extended to 180 days. Effective April 1, 2023, the reasonable opportunity period aligns with OAR 410-200-0015(65);

(c) If the beneficiary fails to submit verification as requested, and the reasonable opportunity period ends during the emergency period, coverage will not be terminated prior to April 1, 2023; and

(d) Upon receipt of verification, the agency will determine ongoing eligibility in accordance with citizenship/non-citizen status requirements described in OAR 410-200-0215.

(8) Federal Pandemic Unemployment Compensation (FPUC) is treated as follows:

(a) FPUC is excluded for all eligibility determinations based on monthly income, as described in 410-200-0310(4)(a).

(b) FPUC is counted for all eligibility determinations based on annual income, as described in 410-200-0310(4)(b).

(9) Disaster relief payments as described in 26 U.S. Code §139 are excluded for all HSD Medical Program eligibility determinations, including determinations made based on both monthly (410-200-0310(4)(a)) and annual (410-200-0310(4)(b)) income.

(10) Individuals receiving Reproductive Health Equity Fund benefits (see OAR 410-200-0240(2)(b)) on March 18, 2020, or who begin receiving RHEF benefits following that date, shall retain RHEF benefits until one of the following occur, whichever is earlier:

(a) The individual becomes eligible for other OHP Plus coverage; or

(b) The individual's eligibility is redetermined during the unwinding period (see OAR 410-200-0521).

Or. Admin. Code § 410-200-0520

DMAP 24-2020, temporary adopt filed 05/08/2020, effective 5/8/2020through 11/03/2020; DMAP 58-2020, adopt filed 11/02/2020, effective 11/3/2020; DMAP 15-2021, temporary amend filed 04/13/2021, effective 04/15/2021 through 10/09/2021; DMAP 44-2021, amend filed 10/05/2021, effective 10/5/2021; DMAP 11-2023, amend filed 03/30/2023, effective 4/1/2023

Statutory/Other Authority: ORS 411.402, 411.404, 413.042 & 414.534

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