OAR 410-200-0100
Coordinated Eligibility and Enrollment Process with the Department of Human Services and the Federally Facilitated Marketplace

(1) This rule describes the coordination of eligibility and enrollment between the Oregon Health Authority (Authority), the 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 (Application and Renewal Processing and Timeliness Standards) 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.
(2) For individuals undergoing eligibility determination for HSD Medical Programs, the Agency, consistent with the timeliness standards described in OAR 410-200-0110 (Application and Renewal Processing and Timeliness Standards), shall:
(a) Determine eligibility for MAGI Medicaid/CHIP on the basis of having household income at or below the applicable MAGI-based standard; or
(b) If ineligible under section (a) or if eligible for CAWEM-level benefits only, direct as appropriate to the FFM.
(3) If ineligible for HSD Medical Programs, the Agency shall, consistent with the timeliness standards described in OAR 410-200-0110 (Application and Renewal Processing and Timeliness Standards), Screen for eligibility for non-MAGI programs as indicated by information provided on the application or renewal form.
(4) For HSD Medical Program beneficiaries who become ineligible for ongoing HSD Medical Program benefits, if an evaluation for non-MAGI programs is indicated by information provided in the case record, the Agency shall maintain HSD Medical Program benefits while eligibility for non-MAGI programs is being determined, and shall not take action to close benefits until determination of eligibility is complete.
(5) Coordination among agencies:
(a) The Agency shall maintain a secure electronic interface through which the Authority can send and receive an individual’s electronic account from the FFM;
(b) The Agency may not request information or documentation from the individual included in the individual’s electronic account or provided for the sake of other Agency benefits; and
(c) If information is available through electronic data match and is useful and related to eligibility for HSD Medical Programs, the Agency shall obtain the information through electronic data match.

Source: Rule 410-200-0100 — Coordinated Eligibility and Enrollment Process with the Department of Human Services and the Federally Facilitated Marketplace, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=410-200-0100.

410–200–0010
Overview 410–200–0015
General Definitions 410–200–0100
Coordinated Eligibility and Enrollment Process with the Department of Human Services and the Federally Facilitated Marketplace 410–200–0105
Hospital Presumptive Eligibility 410–200–0110
Application and Renewal Processing and Timeliness Standards 410–200–0111
Authorized Representatives 410–200–0115
HSD Medical Programs—Effective Dates 410–200–0120
Notices 410–200–0125
Acting on Reported Changes 410–200–0130
Retroactive Medical 410–200–0135
Assumed, Continuous, and Protected Eligibility for Children and Pregnant Individuals 410–200–0140
Eligibility for Inmates 410–200–0145
Contested Case Hearing 410–200–0146
Final Orders, Dismissals and Withdrawals 410–200–0200
Residency Requirements 410–200–0205
Concurrent and Duplicate Program Benefits 410–200–0210
Requirement to Provide Social Security Number 410–200–0215
Citizenship and Non-Citizen Status Requirements 410–200–0220
Requirement to Pursue Assets 410–200–0225
Assignment of Rights 410–200–0230
Verification 410–200–0235
Changes That Must Be Reported 410–200–0240
Eligibility for Individuals Who Do Not Meet the Citizen and Non-Citizen Status Requirements 410–200–0305
Eligibility Determination Group — MAGI Medicaid/CHIP 410–200–0310
Eligibility and Budgeting 410–200–0315
Standards and Determining Income Eligibility 410–200–0400
Specific Requirements 410–200–0405
Specific Requirements 410–200–0407
Specific Requirements—Former Foster Care Youth Medical Program 410–200–0410
Specific Requirements 410–200–0415
Specific Requirements 410–200–0420
Specific Requirements 410–200–0425
Specific Requirements 410–200–0435
Specific Requirements 410–200–0440
Specific Requirements 410–200–0520
COVID-19 Emergency Policies
Last Updated

Jun. 8, 2021

Rule 410-200-0100’s source at or​.us