reglab/statecodes huggingface dataset:
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 180 - RENUMBERED › Section 410-180-0365 - Renumbered

Current through Register Vol. 63, No. 7, July 1, 2024
Statutory/Other Authority: ORS
				  413.042,
				  414.635  & 414.665
Statutes/Other Implemented: ORS
				  414.635  & 414.665
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 180 - RENUMBERED › Section 410-180-0370 - Renumbered

Current through Register Vol. 63, No. 7, July 1, 2024
Statutory/Other Authority: ORS
				  413.042, ORS
				  414.635  & 414.665
Statutes/Other Implemented: ORS
				  414.635,
				  414.665  & 181.537
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 180 - RENUMBERED › Section 410-180-0375 - Renumbered

Current through Register Vol. 63, No. 7, July 1, 2024
Statutory/Other Authority: ORS
				  413.042,
				  414.635  & 414.665
Statutes/Other Implemented: 414.635 &
				  414.665
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 180 - RENUMBERED › Section 410-180-0380 - Renumbered

Current through Register Vol. 63, No. 7, July 1, 2024
Statutory/Other Authority: ORS
				  413.042,
				  414.635  & 414.665
Statutes/Other Implemented: ORS
				  414.635  & 414.665
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0010 - Overview

Current through Register Vol. 63, No. 7, July 1, 2024
These rules, OAR 410-200-0010  through 410-200-0510, describe
				eligibility requirements for the Health Systems Division (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, 414.534,
				  414.536 & 414.706
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0015 - General Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
(1) "Action" means
			 a termination, suspension, denial, or reduction of Medicaid or CHIP eligibility
			 or covered services.
(2) "Active
			 renewal" means the renewal process for cases that are not processed via
			 automated renewal wherein a prepopulated renewal notice is sent to the head of
			 household and authorized representative, if applicable. The active renewal
			 notice is populated with the most current case information relevant to
			 renewal.
(3) "Address
			 Confidentiality Program (ACP)" means a program of the Oregon Department of
			 Justice that provides a substitute mailing address and mail forwarding service
			 for ACP participants who are victims of domestic violence, sexual assault, or
			 stalking.
(4) "AEN" means Assumed
			 Eligible Newborn (OAR 410-200-0115).
(5) "Affordable Care Act" means the Patient
			 Protection and Affordable Care Act of 2010 (Pub. L. 111-148), as amended by
			 the Health Care and Education Reconciliation Act of 2010 (Pub. L. 111-152),
			 as amended by the Three Percent Withholding Repeal and Job Creation Act of 2011
			 (Pub. L.
			 112-56).
(6) "Agency" means the Oregon Health
			 Authority and Oregon Department of Human Services.
(7) "Applicant" means an individual who is
			 seeking an eligibility determination for themselves or someone for whom they
			 are applying through an application submission or a transfer from another
			 agency, insurance affordability program, or the FFM.
(8) "Application" means:
(a) The single streamlined application for
			 all insurance affordability programs developed by the Authority or the FFM;
			 or
(b) An application designed
			 specifically to determine eligibility on a basis other than the applicable MAGI
			 standard, submitted by or on behalf of the individual who may be eligible or is
			 applying for assistance on a basis other than the applicable MAGI
			 standard.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0100 - Coordinated Eligibility and Enrollment Process with the Department of Human Services and the Federally Facilitated Marketplace

Current through Register Vol. 63, No. 7, July 1, 2024
(1) This rule
			 describes the coordination of eligibility and enrollment between the Oregon
			 Health Authority (Authority), the Oregon Department of Human Services
			 (Department), and the FFM. The Agency shall:
(a) Minimize the burden on individuals
			 seeking to obtain or renew eligibility or to appeal a determination of
			 eligibility for insurance affordability programs;
(b) Ensure determinations of eligibility and
			 enrollment in the appropriate program without undue delay, consistent with
			 timeliness standards described in OAR 410-200-0110  based on the application
			 date;
(c) Provide coordinated
			 content for those household members whose eligibility status is not yet
			 determined; and
(d) Screen every
			 applicant or beneficiary who submits an application, renewal, or reports a
			 change requiring redetermination of eligibility for criteria that identify
			 individuals for whom MAGI and MAGI-based income methods do not apply.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0105 - Hospital Presumptive Eligibility

Current through Register Vol. 63, No. 7, July 1, 2024
With the exception of OHP Bridge - Basic Medicaid, this rule
				sets out when an individual is presumptively eligible for MAGI Medicaid/CHIP,
				BCCTP, and FFCYM (OAR 410-200-0407) based on the determination of a qualified
				hospital. In addition, presumptive eligibility for OHP Bridge Basic Health
				Program cannot be established based on the determination of a qualified
				hospital.
(1) A qualified hospital
			 shall, with the consent of the individual or someone acting on the individual's
			 behalf, determine Hospital Presumptive Eligibility (HPE) for MAGI
			 Medicaid/CHIP, BCCTP, or FFCYM.
(2)
			 The qualified hospital shall determine Hospital Presumptive Eligibility based
			 on the following information attested by the individual:
(a) Family size;
(b) Household income;
(c) Receipt of other health
			 coverage;
(d) Residency
(e) US citizenship, US national, or
			 non-citizen status.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0110 - Application and Renewal Processing and Timeliness Standards

Current through Register Vol. 63, No. 7, July 1, 2024
(1) General information as it relates to
			 application processing is as follows:
(a) An
			 individual may apply for one or more medical programs administered by the
			 Authority, the Department, or the Federally Facilitated Marketplace (FFM) using
			 a single streamlined application;
(b) An application may be submitted via the
			 Internet, the FFM, by telephone, by mail, in person, or through other commonly
			 available electronic means;
(c) The
			 Agency shall ensure that an application form is readily available to anyone
			 requesting one and that community partners or Agency staff are available to
			 assist applicants to complete the application process;
(d) If the Agency requires additional
			 information to determine eligibility, the Agency shall send the applicant or
			 beneficiary a request for information (RFI) which includes a statement of the
			 specific information needed to determine eligibility and the date by which the
			 applicant or beneficiary shall provide the required information in accordance
			 with section (6) of this rule.
(e)
			 If an application is filed containing the applicant or beneficiary's name and
			 address, the Agency shall send the applicant or beneficiary a decision notice
			 within the time frame established in section (6) of this rule;
(f) An application is complete if all the
			 following requirements are met:
(A) All
			 information necessary to determine all applicant's eligibility and benefit
			 level is provided on the application for each individual in the EDG;
(B) The applicant, even if homeless, provides
			 an address where they can receive postal mail;
(C) The application is signed in accordance
			 with section (5) of this rule;
(D)
			 The application is received by the Agency.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0111 - Authorized Representatives

Current through Register Vol. 63, No. 7, July 1, 2024
(1) With
			 the exception of individuals who are included in the EDG solely because they
			 are part of a tax-filers tax group (see OAR 410-200-0305) and except as limited
			 in sections (3), (4), and (5) of this rule, the following individuals may
			 appoint an authorized representative on a form designated by the Agency:
(a) The primary contact;
(b) An individual age 18 or older who is
			 included in the EDG with the primary contact, head of household (see OAR
			 461-001-0015), or primary person (see OAR 461-001-0000), for all programs with
			 which the primary contact, head of household, or primary person participates;
(c) An individual given legal
			 guardianship or power of attorney for an individual age 18 and older.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0115 - HSD Medical Programs-Effective Dates

Current through Register Vol. 63, No. 7, July 1, 2024
(1) This section of
			 the rule identifies the effective date of coverage for new applicants who are
			 approved for HSD Medical Program benefits
(a)
			 For all HSD Medical programs except OHP Bridge - Basic Health Program, the
			 effective date is:
(A) The earliest date of
			 eligibility within the month in which the Date of Request is established;
			 or
(B) If ineligible within the
			 month in which the Date of Request was established, the first day within the
			 following month in which the client is determined to be eligible.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0120 - Notices

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Except as
			 provided in this rule, the Authority shall send:
(a) A basic decision notice whenever an
			 application for HSD Medical Program benefits is approved or denied;
(b) A timely continuing benefit decision
			 notice whenever HSD Medical Program benefits are reduced or
			 closed.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0125 - Acting on Reported Changes

Current through Register Vol. 63, No. 7, July 1, 2024
(1) When
			 an HSD Medical Program beneficiary or an individual authorized to act on the
			 beneficiary's behalf reports a change that may affect eligibility, the Agency
			 shall promptly redetermine eligibility before reducing or ending medical
			 benefits.
(2) The Agency may send
			 an RFI to request additional information or verification related to the
			 reported change.
(3) If a
			 beneficiary remains eligible as a result of a redetermination due to a reported
			 change, a new 12-month eligibility period is not established; the original
			 renewal date is maintained.
(4) If
			 the Authority has information about anticipated changes in a beneficiary's
			 circumstances that may affect eligibility, it shall redetermine eligibility at
			 the appropriate time based on the changes.
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
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0130 - Retroactive Medical

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Authority may evaluate for
			 retroactive medical eligibility for all HSD Medical Programs, except
			 retroactive eligibility for OHP Bridge - Basic Health Program is not
			 permitted.
(2) The Authority shall
			 evaluate for retroactive medical eligibility for the three calendar months
			 preceding the month in which the Date of Request was established for the
			 following individuals:
(a) Applicants
			 requesting HSD Medical Programs who have unpaid medical bills or received
			 donated medical services that may have been covered by Oregon Medicaid/CHIP;
			 and
(b) Deceased individuals who
			 have unpaid medical bills or received donated medical services that may have
			 been covered by Oregon Medicaid/CHIP, who may have been eligible for Medicaid
			 covered services had they, or someone acting on their behalf,
			 applied.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0135 - Assumed, Continuous, and Protected Eligibility

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Assumed
			 Eligibility:
(a) A child born to an
			 individual who is eligible for and receiving Medicaid/Children's Health
			 Insurance Program (CHIP) benefits at the time of the birth is an assumed
			 eligible newborn (AEN);
(b) An AEN
			 is eligible for MAGI Child benefits (OAR 410-200-0415) effective the date of
			 birth through the end of the month in which the child turns one year of age,
			 unless:
(A) The child dies;
(B) The child is no longer a resident of
			 Oregon; or
(C) The child's
			 representative requests a voluntary termination of the child's
			 eligibility.
(c) A new
			 application or request for coverage is not required for an AEN.
(d) An AEN is entitled to assumed eligibility
			 without providing a Social Security Number (SSN). An SSN is required to
			 maintain coverage after the assumed eligibility period ends.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0140 - Eligibility for Residents of a Public Institution

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0145 - Contested Case Hearing

Current through Register Vol. 63, No. 7, July 1, 2024
(1) For the
			 purposes of this rule, timely means within 90 days of the date the notice of
			 adverse action is received.
(2)
			 This rule applies to contested case hearings for programs described in OAR
			 chapter 410 division 200, except for individuals receiving HSD Medical Program
			 benefits during a period of Hospital Presumptive Eligibility (OAR
			 410-200-0105). Contested case hearings are conducted in accordance with the
			 Attorney General's model rules OAR 137-003-0501  and following ORS Ch. 183
			 except to the extent that Authority rules provide for different
			 procedures.
(3) The Authority's
			 contested case hearings governed by this rule are not open to the public and
			 are closed to nonparticipants, except nonparticipants may attend subject to the
			 parties' consent and applicable confidentiality laws.
(4) A claimant may request a contested case
			 hearing upon the timely completion of a hearing request in medical assistance
			 programs in the following situations:
(a) The
			 Authority has not approved or denied an application within 45 days of the date
			 of request for benefits or the extended time the Authority has allowed for
			 processing;
(b) The Authority acts
			 to deny, reduce, close, or suspend medical assistance, including the denial of
			 continued benefits pending the outcome of a contested case hearing;
(c) The Authority claims that an earlier
			 medical assistance payment was an overpayment;
(d) A claimant claims that the Authority
			 previously under issued medical assistance;
(e) A claimant disputes the current level of
			 benefits.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0146 - Final Orders, Dismissals and Withdrawals

Current through Register Vol. 63, No. 7, July 1, 2024
(1) When the Authority refers a contested
			 case under chapter 410 division 200 to the Office of Administrative Hearings
			 (OAH), the Authority must indicate on the referral:
(a) Whether the Authority is authorizing a
			 proposed order, a proposed and final order, or a final order; and
(b) If the Authority establishes an earlier
			 deadline for written exceptions and argument because the contested case is
			 being referred for an expedited hearing.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0200 - Residency Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) To be
			 eligible for HSD Medical Programs, an individual must be a resident of
			 Oregon.
(2) An individual is a
			 resident of Oregon if the individual lives in Oregon except:
(a) An individual 21 years of age or older
			 who is placed in a medical facility in Oregon by another state is considered to
			 be a resident of the state that makes the placement if:
(A) The individual is capable of indicating
			 intent to reside; or
(B) The
			 individual became incapable of indicating intent to reside after attaining 21
			 years of age (see section (c) of this part).
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0205 - Concurrent and Duplicate Program Benefits

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An individual receiving HSD Medical
			 Program benefits may not receive the following medical benefits at the same
			 time:
(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);
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0210 - Requirement to Provide Social Security Number

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0215 - Citizenship and Non-Citizen Status Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) To meet
			 the citizenship requirement for an HSD Medical Program, an individual must be:
(a) A citizen of the United States;
			 or
(b) A citizen of Puerto Rico,
			 Guam, the Virgin Islands or Saipan, Tinian, Rota or Pagan of the Northern
			 Mariana Islands; or
(c) A national
			 from American Samoa or Swains Islands.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0220 - Requirement to Pursue Assets

Current through Register Vol. 63, No. 7, July 1, 2024
(1) For all HSD
			 Medical Programs except for OHP Bridge- Basic Health Program, as a condition of
			 ongoing eligibility, an applicant or beneficiary shall make a good faith effort
			 to obtain an asset to which they have a legal right or claim, except an
			 applicant or beneficiary is not required to:
(a) Apply for Supplemental Security Income
			 (SSI) from the Social Security Administration;
(b) Borrow money;
(c) Pursue an asset if the individual can
			 show good cause for not doing so (see section (6) of this rule).
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0225 - Assignment of Rights

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The
			 signature of the applicant or authorized representative on the application for
			 assistance signifies the applicant's agreement to assign the rights to
			 reimbursement for medical care costs to the Agency.
(2) As a condition of eligibility, each
			 applicant shall:
(a) Assign to the Agency any
			 rights of each EDG member receiving benefits to reimbursement for medical care
			 costs to the Agency including any third party payments for medical care and any
			 medical care support available under an order of a court or an administrative
			 agency;
(b) Assign to the Agency
			 any rights to payment for medical care from any third party and, once they
			 receive assistance, to assist the Agency in pursuing any third party who may be
			 liable for medical care or services paid by the Agency, including health
			 services paid for pursuant to ORS
			 414.706 to
			 414.750 as set forth in OAR 410-200-0220, 461-195-0303  and 461-195-0310;
(c) Unless good cause exists as established
			 in OAR 410-200-0220  (Requirement to Pursue Assets), failure to assign the right
			 to reimbursement for medical care costs to the Agency shall result in
			 ineligibility for the EDG until the requirements of this rule are
			 met.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0230 - Verification

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Applicants,
			 beneficiaries, or an individual authorized to act on their behalf shall attest
			 to the following information:
(a) Age and date
			 of birth;
(b) Application for other
			 benefits;
(c) Caretaker relative
			 status;
(d) Household
			 composition;
(e) Legal
			 name;
(f) Medicare;
(g) Pregnancy;
(h) Receipt or availability of other
			 healthcare coverage;
(i)
			 Residency;
(j) Social Security
			 number; and
(k) American
			 Indian/Alaska Native status.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0235 - Changes That Must Be Reported

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Reporting requirements described in this
			 rule apply to any individual whose information is considered in determining
			 eligibility for any case member.
(2) An individual or someone authorized to
			 act on the individuals behalf shall report the following changes in
			 circumstances within 10 calendar days of its occurrence:
(a) The receipt or loss of health care
			 coverage;
(b) A change in mailing
			 or residential address;
(c) A
			 change in legal name;
(d) A change
			 in pregnancy status;
(e) A change
			 in tax-filing status;
(f) A change
			 in citizenship or immigration status of an applicant or recipient;
(g) Someone joins or permanently leaves the
			 household;
(h) Someone becomes a
			 resident of a public institution as described in OAR
			 410-200-0015(69);
(i) For all HSD
			 Medical Programs except MAGI CHIP, a change in availability of
			 employer-sponsored health insurance;
(j) For the MAGI Parent or Caretaker Relative
			 and EXT programs, when the beneficiary no longer has a dependent child living
			 in the home, including:
(A) The only dependent
			 child leaves the household; or
(B)
			 The only dependent child is 18 years old and not a full-time student in a
			 secondary school or equivalent vocational or technical training.
(k) An EDG member age 19 or older
			 experiences a change in income, including:
(A)
			 A change in source of income;
(B) A
			 change in employment status:
(i) For a new
			 job, the change occurs the first day of the new job;
(ii) For a job separation, the change occurs
			 on the last day of employment.
(C) A change in earned income more than $100
			 per month. The change occurs upon the receipt by the beneficiary of the first
			 paycheck from a new job or the first paycheck reflecting the updated income
			 amount;
(D) A change in unearned
			 income more than $50 per month. The change occurs the day the beneficiary
			 receives the new or changed payment.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0240 - Healthier Oregon and Citizenship Waived Medical and Citizenship Waived Medical Plus Benefits

Current through Register Vol. 63, No. 7, July 1, 2024
(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, except the MAGI Expanded Adult 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, other than the MAGI Expanded Adult
			 program; and
(C) Did not meet the
			 Citizenship and Non-Citizen Status Requirements set forth in OAR
			 410-200-0215;
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0305 - Eligibility Determination Group - Health System Division Medical Programs

Current through Register Vol. 63, No. 7, July 1, 2024
(1) When establishing eligibility for MAGI
			 Medicaid/CHIP, each applicant or beneficiary shall have their own Eligibility
			 Determination Group (EDG) determined individually based on the following EDG
			 rules:
(a) Tax filer EDG:
(A) For individuals who intend to file a
			 federal income tax return, who are not claimed as a tax dependent by another
			 individual, the EDG consists of:
(i) The tax
			 filer;
(ii) The tax filer's spouse,
			 with the following considerations:
(I) If
			 living together, the tax filer's spouse is included in the EDG of the tax
			 filer, irrespective of the spouse's tax filing status; and
(II) If living separately, the tax filer's
			 spouse is included in the EDG of tax filer if they intend to claim a tax filing
			 status of Married Filing Jointly.
(iii) All individuals whom the tax filer
			 intends to claim as tax dependents.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0310 - Eligibility and Budgeting; Health Systems Division Medical Programs

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Eligibility is evaluated by reviewing the
			 financial and non-financial information for the applicable budget months. The
			 budget month is established as follows.
(a)
			 For new applicants, the budget month is:
(A)
			 The initial budget month is the month in which the Date of Request (DOR) is
			 established; or
(B) If ineligible
			 in the initial budget month, the agency shall evaluate eligibility for the
			 subsequent month.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0315 - Standards and Determining Income Eligibility

Current through Register Vol. 63, No. 7, July 1, 2024
(1) This rule
			 outlines income thresholds for Health System Division (HSD) Medical Programs.
			 See OAR 410-200-0310  for eligibility and budgeting.
(2) The income standard for the Modified
			 Adjusted Gross Income (MAGI) Parent or Caretaker-Relative program is set as
			 follows: See attached table.
(3)
			 Effective March 1, 2024, the income standard for the MAGI Child Program and the
			 MAGI Adult Program is set at 133 percent of the 2024 Federal Poverty Level
			 (FPL) as follows: See attached table.
(4) Effective March 1, 2024, the income
			 standard for the MAGI Pregnant Woman Program and for MAGI Child Program
			 recipients under the age of one year is set at 185 percent of the 2024 FPL as
			 follows: See attached table.
(5)
			 Effective March 1, 2024, the income standard for the MAGI Expanded Adult
			 Program is set at 200 percent of the 2024 FPL as follows: See attached
			 table.
(6) Effective March 1, 2024,
			 the income standard for MAGI Children's Health Insurance Program (CHIP) is set
			 at 300 percent of the 2024 FPL as follows: See attached table.
(7) Effective March 1, 2024, the income
			 standard for the Compact of Free Association (COFA) Dental Program is set at
			 138 percent of the 2024 FPL as follows: See attached table.
(8) Effective March 1, 2024, the income
			 standard for the Veteran Dental Program is set at 400 percent of the 2024 FPL
			 as follows: See attached table.
To view attachments referenced in rule text,
click here to view
				  rule
.
Statutory/Other Authority:
				  42 CFR
				  435.110, ORS 435.112, 435.115, 435.116,
				  435.118, 435.403, 435.940, 435.1200, 457.80, 457.340, 458.350, 435.3, 435.4,
				  435.406, 435.407, 435.940, 435.952, 435.956, 435.1008, 457.320, 457.380,
				  435.608, 433.138, 433.145, 433.146, 433.147, 433.148, 435.117, 435.119,
				  435.1200, 435.1205, 435.170, 435.190, 435.222, 435.610, 435.916, 435.917,
				  447.56, 457.350, 457.360, 457.805, ORS
				  411.402,
				  411.404,
				  413.042 & 414.534
Statutes/Other Implemented: ORS
				  411.402,
				  411.404, ORS
				  411.060,
				  411.095,
				  411.400,
				  411.406,
				  411.439,
				  411.443,
				  413.032,
				  413.038,
				  414.025,
				  414.231,
				  414.440,
				  414.534,
				  414.536 &
				  414.706
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0315 - Standards and Determining Income Eligibility

Current through Register Vol. 63, No. 7, July 1, 2024
(1) This rule outlines income thresholds for
			 Health System Division (HSD) Medical Programs. See OAR 410-200-0310  for
			 eligibility and budgeting.
(2) The
			 income standard for the Modified Adjusted Gross Income (MAGI) Parent or
			 Caretaker-Relative program is set as follows: See attached table.
(3) Effective March 1, 2024, the income
			 standard for the MAGI Child Program and the MAGI Adult Program is set at 133
			 percent of the 2024 Federal Poverty Level (FPL) as follows: See attached
			 table.
(4) Effective March 1, 2024,
			 the income standard for the MAGI Pregnant Woman Program and for MAGI Child
			 Program recipients under the age of one year is set at 185 percent of the 2024
			 FPL as follows: See attached table.
(5) Effective March 1, 2024, the income
			 standard for the MAGI Expanded Adult Program is set at 200 percent of the 2024
			 FPL as follows: See attached table.
(6) Effective March 1, 2024, the income
			 standard for MAGI Children's Health Insurance Program (CHIP) is set at 300
			 percent of the 2024 FPL as follows: See attached table.
(7) Effective July 1, 2024, the income
			 standard for OHP Bridge - Basic Health Program and OHP Bridge - Basic Medicaid
			 is set at 200 percent of the 2024 Federal Poverty Level (FPL) as follows: See
			 attached table.
(8) Effective March
			 1, 2024, the income standard for the Compact of Free Association (COFA) Dental
			 Program is set at 138 percent of the 2024 FPL as follows: See attached
			 table.
(9) Effective March 1, 2024,
			 the income standard for the Veteran Dental Program is set at 400 percent of the
			 2024 FPL as follows: See attached table.
To view attachments referenced in rule text, click here for
				  PDF copy.
Statutory/Other Authority:
				  42 CFR
				  435.110, ORS 435.112, 435.115, 435.116,
				  435.118, 435.403, 435.940, 435.1200, 457.80, 457.340, 458.350, 435.3, 435.4,
				  435.406, 435.407, 435.940, 435.952, 435.956, 435.1008, 457.320, 457.380,
				  435.608, 433.138, 433.145, 433.146, 433.147, 433.148, 435.117, 435.119,
				  435.1200, 435.1205, 435.170, 435.190, 435.222, 435.610, 435.916, 435.917,
				  447.56, 457.350, 457.360, 457.805, ORS
				  411.402,
				  411.404,
				  413.042 & 414.534
Statutes/Other Implemented: ORS
				  411.402,
				  411.404, ORS
				  411.060,
				  411.095,
				  411.400,
				  411.406,
				  411.439,
				  411.443,
				  413.032,
				  413.038,
				  414.025,
				  414.231,
				  414.440,
				  414.534,
				  414.536 &
				  414.706
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0400 - Specific Requirements; Breast and Cervical Cancer Treatment Program (BCCTP)

Current through Register Vol. 63, No. 7, July 1, 2024
This rule establishes eligibility criteria for medical
				assistance based on an individual's need of treatment for breast or cervical
				cancer, including pre-cancerous conditions (treatment). The Authority
				administers the Oregon Breast and Cervical Cancer Treatment Program (BCCTP) by
				entering into agreements with qualified entities as approved by the Authority
				to provide screening services for BCCTP funded by the Centers for Disease
				Control in support of the National Breast and Cervical Cancer Early Detection
				Program.
(1) To be eligible for BCCTP,
			 an individual must:
(a) Be found to need
			 treatment following screening services provided by a qualified
			 entity;
(b) Be under the age of
			 65;
(c) Not be covered for
			 treatment by minimum essential coverage; and
(d) Not be receiving Medicaid through a
			 Medicaid program listed in
			 42 U.S.C. §
										1396a(a)(10)(A)(i)
			 (mandatory Medicaid eligibility groups).
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0405 - Specific Requirements; Substitute Care

Current through Register Vol. 63, No. 7, July 1, 2024
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 an
			 intermediate psychiatric care facility 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
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0407 - Specific Requirements-Former Foster Care Youth Medical Program

Current through Register Vol. 63, No. 7, July 1, 2024
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 an adult at least
			 age 18 and under age 26;
(b) Is not
			 eligible for MAGI Child, MAGI CHIP, MAGI Pregnant Woman, or MAGI Parent or
			 Caretaker Relative benefits;
(c)
			 Was in foster care under the responsibility of the Oregon Department of Human
			 Services or tribe and enrolled in Child Welfare Title XIX Medicaid upon
			 attaining:
(A) Age 18; or
(B) If over 18, the age at which Oregon
			 Medicaid or Oregon tribal foster care assistance ended under Title IV-E of the
			 Act.
(d) Is not
			 receiving Supplemental Security Income (SSI);
(e) Is not receiving adoption assistance or
			 foster care maintenance payments.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0410 - Specific Requirements; MAGI CHIP

Current through Register Vol. 63, No. 7, July 1, 2024
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.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0415 - Specific Requirements; MAGI Child

Current through Register Vol. 63, No. 7, July 1, 2024
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.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0420 - Specific Requirements; MAGI Parent or Caretaker Relative

Current through Register Vol. 63, No. 7, July 1, 2024
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.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0425 - Specific Requirements; MAGI Pregnant Woman

Current through Register Vol. 63, No. 7, July 1, 2024
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, or be within the
			 two calendar months following the month in which their pregnancy
			 ended.
(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.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0435 - Specific Requirements; MAGI Adult

Current through Register Vol. 63, No. 7, July 1, 2024
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.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0436 - Specific Requirements: MAGI Expanded Adult Program

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Modified Adjusted Gross Income (MAGI)
			 Expanded Adult program is effective April 1, 2023
(2) Notwithstanding any other rule to the
			 contrary in these Chapter 410, Division 200 rules, the MAGI Expanded Adult
			 Program shall be closed to new enrollment effective July 1, 2024. Beginning in
			 June 2024, eligibility for MAGI Expanded Adult Program recipients shall be
			 redetermined, and:
(a) If determined eligible
			 for any OHP Plus program shall be transitioned to that program,
(b) If determined eligible for a medical
			 program that provides reduced benefits, including an OHP Bridge program, shall
			 be transitioned to that program, with timely notice as described in OAR
			 410-200-0015 (32)(c).
(c) If
			 determined ineligible for any medical assistance program, shall be terminated
			 with timely notice as described in OAR 410-200-0521 (8)
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0436 - Specific Requirements: MAGI Expanded Adult Program

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Modified
			 Adjusted Gross Income (MAGI) Expanded Adult program is effective April 1,
			 2023.
(2) Individuals who lose
			 eligibility for other OHP Plus medical benefits due to an increase of countable
			 income may be eligible for the MAGI Expanded Adult program if they:
(a) Are 19 years of age or older and under
			 age 65;
(b) Have household income
			 greater than 138 percent federal poverty level through 200 percent federal
			 poverty level (OAR 410-200-0315) for the applicable family size;
(c) Meet citizenship or non-citizen status
			 requirements outlined in OAR 410-200-0215;
(d) Are not entitled to or enrolled in
			 Medicare benefits under part A or B of Title XVIII of the Act; and
(e) Are not receiving SSI benefits.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 200 - ELIGIBILITY FOR HEALTH SYSTEMS DIVISION MEDICAL PROGRAMS › Section 410-200-0437 - Specific Requirements: OHP Bridge - Basic Medicaid

Current through Register Vol. 63, No. 7, July 1, 2024
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).