justicedao/ipfs_state_laws huggingface dataset:
410-200-0205 Concurrent and Duplicate Program Benefits (1) An individual receiving HSD Medical Program benefits may not receive the following medical benefits at the same time except as described in section (3) of this rule: (a) Any other HSD Medical Program; (b) Office of Child Welfare Medical; (c) Oregon Youth Authority Medical; (d) Oregon Supplemental Income Program-Medical (OSIPM); or (e) Refugee Medical Assistance (REFM). (2) An individual may not receive HSD Medical Program benefits and medical benefits from another state unless the individual’s provider refuses to submit a bill to the Medicaid/CHIP agency of the other state and the individual would not otherwise receive medical care. (3) Individuals may receive the supplemental YSHCN program benefits as described in OAR 410-200-0455(2)(a) and (b) concurrent with the MAGI Medicaid/CHIP programs defined in OAR 410-200-0015(d) and 410-200-0015(f)(A)-(E), and OSIPM programs as defined in OAR 461-101-0010(18). Statutory/Other Authority: ORS 411.402, 411.404, 413.042 & 414.534 Statutes/Other Implemented: ORS 411.400, 411.402, 411.404, 411.406, 411.439, 411.443, 413.032, 413.038, 414.025, 414.231, 414.447, 414.534, 414.536 & 414.706 History: DMAP 138-2024, amend filed 11/26/2024, effective 01/01/2025 DMAP 23-2020, amend filed 05/07/2020, effective 05/08/2020 DMAP 3-2015, f. & cert. ef. 1-30-15 DMAP 67-2014(Temp), f. 11-14-14, cert. ef. 11-15-14 thru 5-13-15 DMAP 20-2014, f. & cert. ef. 3-28-14 DMAP 4-2014(Temp), f. & cert. ef. 1-15-14 thru 3-30-14 DMAP 54-2013(Temp), f. & cert. ef. 10-1-13 thru 3-30-14
410-200-0210 Requirement to Provide Social Security Number (1) The Agency may collect a Social Security Number (SSN) for the following purposes: (a) The determination of eligibility for benefits. The SSN is used to verify income and other assets and to match with other state and federal records such as the Internal Revenue Service (IRS), Medicaid, spousal support, Social Security benefits, and unemployment benefits; (b) The preparation of aggregate information and reports requested by funding sources for the program providing benefits; (c) The operation of the program applied for or providing benefits; (d) Conducting quality assessment and improvement activities; (e) Verifying the correct amount of payments, recovering overpaid benefits, and identifying any individual receiving benefits in more than one household. (2) As a condition of eligibility, except as provided in section (6) below, each applicant (including children) requesting medical benefits shall: (a) Provide a valid SSN; or (b) Apply for an SSN if the individual does not have one and provide the SSN when it is received. (3) The agency may not deny or delay services to an otherwise eligible individual pending issuance or verification of the individual’s SSN or if the individual meets one of the exceptions identified in section (6). (4) Except as provided in section (6) below, if an applicant does not recall their SSN or has not been issued an SSN and the SSN is not available to the Agency, the Agency shall: (a) Obtain required evidence under SSA regulations to establish the age, the citizenship, or non-citizen status and the true identity of the applicant; and (b) Either assist the applicant in completing an application for an SSN or, if there is evidence that the applicant has previously been issued an SSN, request SSA to furnish the number. (5) The Agency may request that non-applicants provide an SSN on a voluntary basis. The Agency shall use the SSN for the purposes outlined in section (1). (6) An applicant is not required to apply for or provide an SSN if the individual: (a) Does not have an SSN and the SSN may be issued only for a valid-non-work reason; (b) Is not eligible to receive an SSN; (c) Is a member of a religious sect or division of a religious sect, and the individual adheres to its tenets or teachings, and for that reason is opposed to applying for or using a national identification number; or (d) Is a newborn that is assumed eligible based on the eligibility of the mother of the newborn and who is under one year of age. Statutory/Other Authority: ORS 411.402, 411.404, 413.042 & 414.534 Statutes/Other Implemented: ORS 411.400, 411.402, 411.404, 411.406, 413.032, 413.038, 414.025, 414.231, 414.534, 414.536 & 414.706 History: DMAP 60-2025, amend filed 08/08/2025, effective 08/15/2025 DMAP 23-2020, amend filed 05/07/2020, effective 05/08/2020 DMAP 3-2015, f. & cert. ef. 1-30-15 DMAP 67-2014(Temp), f. 11-14-14, cert. ef. 11-15-14 thru 5-13-15 DMAP 20-2014, f. & cert. ef. 3-28-14 DMAP 4-2014(Temp), f. & cert. ef. 1-15-14 thru 3-30-14 DMAP 54-2013(Temp), f. & cert. ef. 10-1-13 thru 3-30-14
410-200-0240 Healthier Oregon and Citizenship Waived Medical and Citizenship Waived Medical Plus Benefits (1) Healthier Oregon: (a) Healthier Oregon benefits include Cover All Kids as of July 1, 2022, and are equal to OHP Plus benefits as defined in OAR 410-120-1210. (b) Effective July 1, 2023, individuals are eligible for Healthier Oregon benefits if they: (A) Meet all eligibility requirements for an HSD Medical Program; and (B) Do not meet the Citizenship and Non-Citizen Status Requirements set forth in OAR 410-200-0215; (c) Through June 30, 2023, individuals were eligible for Healthier Oregon benefits if they were; (A) Age 0 through 25 or age 55 and older; (B) Met all eligibility requirements for an HSD Medical Program; and (C) Did not meet the Citizenship and Non-Citizen Status Requirements set forth in OAR 410-200-0215; (2) Citizenship Waived Medical (CWM) and Citizenship Waived Medical Plus (CWM Plus): (a) Individuals eligible for CWM and CWM Plus through June 30, 2023, received benefits as defined in OAR 410-134-0005(2). (b) To be eligible for CWM benefits, an individual must have: (A) Been age 26 or older and under age 55; (B) Met all eligibility requirements for an HSD Medical Program; and (C) Did not meet the Citizenship and Non-Citizen Status Requirements set forth in OAR 410-200-0215. (c) To be eligible for CWM Plus benefits, an individual must have met the CWM eligibility requirements described in section (b) of this rule and must have been pregnant or in their protected postpartum eligibility period as described in OAR 410-200-0135(3)(b)(B). Statutory/Other Authority: ORS 411.060, 411.402, 411.404, 413.042, 414.025 & 414.534 Statutes/Other Implemented: ORS 411.400, 411.402, 411.404, 411.406, 411.439, 411.443, 413.032, 414.025, 414.231, 414.534, 414.536 & 414.706 History: DMAP 63-2025, amend filed 08/28/2025, effective 09/01/2025 DMAP 89-2023, amend filed 12/19/2023, effective 12/20/2023 DMAP 55-2023, temporary amend filed 06/30/2023, effective 07/01/2023 through 12/27/2023 DMAP 83-2022, amend filed 11/29/2022, effective 11/29/2022 DMAP 65-2022, amend filed 06/30/2022, effective 07/01/2022 DMAP 42-2022, temporary amend filed 03/29/2022, effective 04/01/2022 through 09/27/2022 DMAP 30-2022, minor correction filed 02/16/2022, effective 02/16/2022 DMAP 23-2020, amend filed 05/07/2020, effective 05/08/2020 DMAP 86-2018, amend filed 08/23/2018, effective 09/11/2018 DMAP 24-2018, temporary amend filed 04/27/2018, effective 04/29/2018 through 10/25/2018 DMAP 23-2018, amend filed 04/27/2018, effective 04/29/2018 DMAP 44-2017, temporary amend filed 11/01/2017, effective 11/01/2017 through 04/29/2018 DMAP 24-2016, f. & cert. ef. 6-2-16 DMAP 78-2015(Temp), f. & cert. ef. 12-22-15 thru 6-18-16 DMAP 3-2015, f. & cert. ef. 1-30-15 DMAP 67-2014(Temp), f. 11-14-14, cert. ef. 11-15-14 thru 5-13-15 DMAP 20-2014, f. & cert. ef. 3-28-14 DMAP 4-2014(Temp), f. & cert. ef. 1-15-14 thru 3-30-14 DMAP 54-2013(Temp), f. & cert. ef. 10-1-13 thru 3-30-14
410-200-0405 Specific Requirements; Substitute Care In addition to eligibility requirements applicable to the Substitute Care program in other rules in chapter 410 division 200, this rule describes specific eligibility requirements for the Substitute Care program, effective 10/01/13. (1) To be eligible for Substitute Care, an individual shall be under the age of 21 and live in a Behavioral Rehabilitation Services (BRS) facility or an intermediate Psychiatric Residential Treatment Facility (PRTF) for which a public agency of Oregon is assuming at least partial financial responsibility, including those placed in an intermediate psychiatric care facility by the Oregon Youth Authority. (2) While living in an intermediate psychiatric care facility, an individual’s EDG consists of the individual only. (3) There is no income test for Substitute Care. Statutory/Other Authority: ORS 411.402, 411.404 & 413.042 Statutes/Other Implemented: ORS 411.400, 411.402, 411.404, 411.406, 413.032, 413.038, 414.025, 414.231 & 414.706 History: DMAP 63-2025, amend filed 08/28/2025, effective 09/01/2025 DMAP 23-2020, amend filed 05/07/2020, effective 05/08/2020 DMAP 3-2015, f. & cert. ef. 1-30-15 DMAP 67-2014(Temp), f. 11-14-14, cert. ef. 11-15-14 thru 5-13-15 DMAP 20-2014, f. & cert. ef. 3-28-14 DMAP 4-2014(Temp), f. & cert. ef. 1-15-14 thru 3-30-14 DMAP 54-2013(Temp), f. & cert. ef. 10-1-13 thru 3-30-14
410-200-0407 Specific Requirements; Former Foster Care Youth Medical Program This rule describes specific eligibility requirements for the Former Foster Care Youth Program (FFCYM). (1) There is no income test for the FFCYM Program. (2) An individual is eligible for the FFCYM Program if the individual meets the requirements of all of the following: (a) Is at least age 18 and under age 26; (b) Was in foster care under the responsibility of any state or a Tribe within that state and was enrolled in Medicaid under the State's Medicaid State plan or under a section 1115 demonstration project upon attaining: (A) Age 18; or (B) If over 18, the age at which that state’s or Tribe within that state’s foster care assistance ended under Title IV-E of the Act. (c) Is not receiving Supplemental Security Income (SSI); (d) Is not receiving adoption assistance or foster care maintenance payments. Statutory/Other Authority: ORS 411.402, 411.404, 413.042 & 414.534 Statutes/Other Implemented: ORS 411.060, 411.095, 411.400, 411.402, 411.404, 411.406, 411.439, 411.443, 411.447, 413.032, 413.038, 414.025, 414.231, 414.534, 414.536 & 414.706 History: DMAP 63-2025, amend filed 08/28/2025, effective 09/01/2025 DMAP 23-2020, amend filed 05/07/2020, effective 05/08/2020 DMAP 23-2016, f. & cert. ef. 6-2-16 DMAP 73-2015(Temp), f. & cert. ef. 12-18-15 thru 6-14-16
410-200-0410 Specific Requirements; MAGI CHIP In addition to eligibility requirements applicable to MAGI CHIP in other rules in chapter 410 division 200, this rule describes specific eligibility requirements for the MAGI CHIP program. (1) Individuals may not be eligible for MAGI CHIP with an effective date prior to October 1, 2013. (2) To be eligible for MAGI CHIP, an individual must: (a) Be under 19 years of age; and (b) Meet the budgeting requirements of OAR 410-200-0315. (3) To be eligible for MAGI CHIP, an individual may not: (a) Be eligible for MAGI Child, MAGI Pregnant Woman, MAGI Parent or Caretaker Relative, or Substitute Care programs; (b) Be receiving or deemed to be receiving SSI benefits; and (c) Be covered by minimum essential coverage. For the purposes of this rule, a child is not considered to have minimum essential coverage if it is not accessible for one or more of the following reasons: (A) The travel time or distance to available providers within the minimum essential coverage network exceeds: (i) In urban areas: 30 miles, 30 minutes, or the community standard, whichever is greater; or (ii) In rural areas: 60 miles, 60 minutes, or the community standard, whichever is greater; (B) Accessing the minimum essential coverage would place a member of the household at risk of harm. (4) For the Authority to enroll a child in MAGI CHIP based on a determination made by an Express Lane Agency (ELA), the child’s parent or guardian shall give consent in writing, by telephone, orally, or through electronic signature. Statutory/Other Authority: ORS 411.402, 411.404 & 413.042 Statutes/Other Implemented: ORS 411.400, 411.402, 411.404, 411.406, 413.032, 413.038, 414.025, 414.231 & 414.706 History: DMAP 23-2020, amend filed 05/07/2020, effective 05/08/2020 DMAP 3-2015, f. & cert. ef. 1-30-15 DMAP 67-2014(Temp), f. 11-14-14, cert. ef. 11-15-14 thru 5-13-15 DMAP 20-2014, f. & cert. ef. 3-28-14 DMAP 4-2014(Temp), f. & cert. ef. 1-15-14 thru 3-30-14 DMAP 54-2013(Temp), f. & cert. ef. 10-1-13 thru 3-30-14
410-200-0415 Specific Requirements; MAGI Child In addition to eligibility requirements applicable to the MAGI Child program in other rules in chapter 410 division 200, this rule describes specific eligibility requirements for the MAGI Child program. (1) To be eligible for the MAGI Child program, the child must: (a) Be under the age of 19; and (b) With the exception of section (3) below, have household income at or below: (A) 133 percent of the federal poverty level (OAR 410-200-0315) for the applicable family size for a child over the age of one but less than age 19; or (B) 185 percent of the federal poverty level for the applicable family size for an infant under the age of one. (2) A child born to an individual who is eligible for and receiving Medicaid/CHIP benefits is an Assumed Eligible Newborn (AEN) for the MAGI Child program until the end of the month in which the child turns one year of age (see OAR 410-200-0135). There is no income limit for an AEN. (3) To be eligible for the MAGI Child Program, an individual may not: (a) Be receiving or deemed to be receiving SSI benefits; (b) Be eligible for Substitute Adoptive Care, MAGI Parent and Caretaker Relative, or MAGI Pregnant Woman programs. (4) To enroll a child in the MAGI Child program based on a determination made by an Express Lane Agency (ELA), the child's parent or guardian shall give consent in writing, by telephone, orally, or through electronic signature. (5) ELE qualifies a child for medical assistance benefits based on a finding from the Department, even when the Department’s eligibility methodology differs from that used for HSD Medical Programs. Statutory/Other Authority: ORS 411.402, 411.404 & 413.042 Statutes/Other Implemented: ORS 411.400, 411.402, 411.404, 411.406, 411.439, 411.443, 413.032, 413.038, 414.025, 414.231, 414.447 & 414.706 History: DMAP 23-2020, amend filed 05/07/2020, effective 05/08/2020 DMAP 24-2016, f. & cert. ef. 6-2-16 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. 1-30-15; ; DMAP 78-2015(Temp), f. & cert. ef. 12-22-15 thru 6-18-16
410-200-0420 Specific Requirements; MAGI Parent or Caretaker Relative In addition to eligibility requirements applicable to the MAGI Parent or Caretaker Relative program in other rules in chapter 410 division 200, this rule describes specific eligibility requirements for the MAGI Parent or Caretaker Relative program. (1) To be eligible for the MAGI Parent or Caretaker Relative program, an individual must meet the criteria outlined in section (2) or (3) of this rule. (2) An individual is eligible for the MAGI Parent or Caretaker Relative Program if they meet the financial and non-financial eligibility requirements as follows: (a) Is a parent, caretaker relative, or spouse of the parent or caretaker relative who assumes primary responsibility for a dependent child living in the home; and (b) Has EDG income at or below the income standard for the applicable family size as identified in OAR 410-200-0315. (3) An individual is eligible for the MAGI Parent or Caretaker Relative program if they are entitled to a period of Continuous Eligibility OAR 410-200-0240(2) and do not meet the financial and non-financial eligibility requirements for any Health System Division (HSD) medical or OSIPM program OAR 461-135-0010 subject to Continuous Eligibility of the same benefit level. Statutory/Other Authority: ORS 411.402, 411.404 & 413.042 Statutes/Other Implemented: ORS 411.400, 411.402, 411.404, 411.406, 411.439, 411.443, 413.032, 414.025, 414.231, 414.447 & 414.706 History: DMAP 40-2024, amend filed 02/01/2024, effective 02/01/2024 DMAP 57-2023, temporary amend filed 07/17/2023, effective 07/18/2023 through 01/12/2024 DMAP 56-2023, temporary amend filed 07/17/2023, effective 07/17/2023 through 07/17/2023 DMAP 23-2020, amend filed 05/07/2020, effective 05/08/2020 DMAP 3-2015, f. & cert. ef. 1-30-15 DMAP 67-2014(Temp), f. 11-14-14, cert. ef. 11-15-14 thru 5-13-15 DMAP 20-2014, f. & cert. ef. 3-28-14 DMAP 4-2014(Temp), f. & cert. ef. 1-15-14 thru 3-30-14 DMAP 54-2013(Temp), f. & cert. ef. 10-1-13 thru 3-30-14
410-200-0425 Specific Requirements; MAGI Pregnant Woman In addition to eligibility requirements applicable to the MAGI Pregnant Woman program in other rules in chapter 410 division 200, this rule describes specific eligibility requirements for the MAGI Pregnant Woman program. (1) To be eligible for the MAGI Pregnant Woman program, an individual must be pregnant at least one day in the month for which eligibility is being determined, including months they are being evaluated for Retroactive Medical (OAR 410-200-0130). (2) To be eligible for the MAGI Pregnant Woman program, an individual must: (a) Have household income that is at or below 185 percent of the federal poverty level (OAR 410-200-0315); or (b) Be eligible for protected eligibility according to the policy described in OAR 410-200-0135. (3) To be eligible for the MAGI Pregnant Woman program, an individual must not be receiving Supplemental Security Income (SSI). Statutory/Other Authority: ORS 411.402, 411.404 & 413.042 Statutes/Other Implemented: ORS 411.400, 411.402, 411.404, 411.406, 411.439, 411.443, 413.032, 414.025, 414.231, 414.447 & 414.706 History: DMAP 63-2025, amend filed 08/28/2025, effective 09/01/2025 DMAP 23-2020, amend filed 05/07/2020, effective 05/08/2020 DMAP 24-2016, f. & cert. ef. 6-2-16 DMAP 78-2015(Temp), f. & cert. ef. 12-22-15 thru 6-18-16 DMAP 3-2015, f. & cert. ef. 1-30-15 DMAP 67-2014(Temp), f. 11-14-14, cert. ef. 11-15-14 thru 5-13-15 DMAP 20-2014, f. & cert. ef. 3-28-14 DMAP 4-2014(Temp), f. & cert. ef. 1-15-14 thru 3-30-14 DMAP 54-2013(Temp), f. & cert. ef. 10-1-13 thru 3-30-14
410-200-0435 Specific Requirements; MAGI Adult In addition to eligibility requirements applicable to the MAGI Adult program in other rules in chapter 410 division 200, this rule describes specific eligibility requirements for the MAGI Adult program. (1) To be eligible for the MAGI Adult program an individual must: (a) Be 19 years of age or older and under age 65; and (b) Have household income at or below 133 percent federal poverty level (OAR 410-200-0315) for the applicable family size. (2) To be eligible for the MAGI Adult program, an individual may not be: (a) Pregnant; (b) Entitled to or enrolled for Medicare benefits under part A or B of Title XVIII of the Act; (c) Receiving SSI benefits; or (d) A parent or caretaker relative of a child living in the home who is not enrolled in minimum essential coverage. Statutory/Other Authority: ORS 411.402, 411.404 & 413.042 Statutes/Other Implemented: ORS 411.400, 411.402, 411.404, 411.406, 411.439, 411.443, 413.032, 413.038, 414.025, 414.231, 414.447 & 414.706 History: DMAP 23-2020, amend filed 05/07/2020, effective 05/08/2020 DMAP 3-2015, f. & cert. ef. 1-30-15 DMAP 67-2014(Temp), f. 11-14-14, cert. ef. 11-15-14 thru 5-13-15 DMAP 20-2014, f. & cert. ef. 3-28-14 DMAP 4-2014(Temp), f. & cert. ef. 1-15-14 thru 3-30-14 DMAP 54-2013(Temp), f. & cert. ef. 10-1-13 thru 3-30-14
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. 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 History: DMAP 94-2024, adopt filed 05/29/2024, effective 06/01/2024