410-200-0140 Eligibility for Residents of a Public Institution (1) A resident of a public institution is not eligible for Health System Division (HSD) Medical Program benefits, except as follows: (a) For individuals residing in an Institution for Mental Disease (IMD), including the Oregon State Hospital, who are: (A) Under age 21; (B) Age 21 if they were admitted to the IMD before their 21st birthday; or (C) Age 65 or older. (b) Residents of a public institution may be eligible for OHP Bridge – Basic Health Program benefits if they are awaiting disposition of charges. (2) For all individuals enrolled in HSD Medical Programs except for OHP Bridge – Basic Health Program who become a resident of a public institution, benefits shall be suspended for the duration of the period in which the individual is a resident of that institution. (a) The effective date of the suspension of benefits is the day following the date on which an individual becomes a resident of a public institution. (b) Except as described in section (2)(c) of this rule, suspended benefits shall be reinstated to the same level of coverage the individual was receiving when they became a resident of a public institution effective the date on which an individual ceases to be a resident of a public institution without the need for a new application when: (A) The Agency learns the individual is no longer a resident of a public institution within the twelve (12) calendar months following the date on which the change occurred; or (B) The individual leaves the public institution to be admitted to a medical facility as an inpatient with an expected stay of at least 24 hours, provided the medical facility is not associated with the public institution where the individual is a resident. (c) Individuals who were in the YSHCN program when they became a resident of a public institution and who have turned age 26 on or prior to their release date shall not have the supplemental YSHCN benefits described in OAR 410-200-0455(2)(a) and (b) reinstated upon their release. (d) Once benefits are reinstated as described in subsection (2)(b) of this rule, a redetermination of eligibility shall be processed unless benefits are restored on a case where the existing renewal date is more than two (2) calendar months beyond the month in which the action is being taken. (3) For individuals enrolled in OHP Bridge – Basic Health Program who become a resident of a public institution, benefits shall be terminated effective the day following the day on which they became a resident of a public institution except that coverage shall be maintained while the individual’s charges are pending disposition. In order to regain eligibility for OHP Bridge-Basic Health Program following release from the public institution, the individual must reapply. Statutory/Other Authority: ORS 411.095, 411.402, 411.404, 413.038, 414.025 & 414.534 Statutes/Other Implemented: ORS 411.070, 411.404, 411.439, 411.443, 411.445, 411.816, 412.014, 412.049 & 414.426 History: DMAP 138-2024, amend filed 11/26/2024, effective 01/01/2025 DMAP 94-2024, amend filed 05/29/2024, effective 06/01/2024 DMAP 12-2023, amend filed 03/30/2023, effective 04/01/2023 DMAP 67-2020, amend filed 12/22/2020, effective 01/01/2021 DMAP 33-2020, temporary amend filed 06/29/2020, effective 07/06/2020 through 01/01/2021 DMAP 23-2020, amend filed 05/07/2020, effective 05/08/2020 DMAP 25-2018, amend filed 05/01/2018, effective 05/01/2018 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