OAR 413-100-0430
Eligibility Determination for a Child or Young Adult in Substitute Care
(1)
Before a child or young adult in substitute care may receive a medical card providing Child Welfare Title XIX Medicaid services, the Department must determine the eligibility of the child or young adult for Child Welfare Title XIX Medicaid.(2)
A child or young adult covered by OAR 413-100-0420 (Child Welfare Title XIX Medicaid Program Eligible Populations) who meets one of the following criteria is categorically eligible for Child Welfare Title XIX Medicaid:(a)
Is eligible for Title IV-E foster care payments; or(b)
Is receiving Supplemental Security Income (SSI).(3)
As part of the eligibility determination for Child Welfare Title XIX Medicaid:(a)
The child or young adult must meet the citizenship and alien status requirements in OAR 413-100-0460 (Citizenship and Alienage).(b)
All income and resources will be disregarded except as described in (3)(d) of this section.(c)
The child or young adult must have a verified Social Security number (SSN) or verification that an application for an SSN has been made and is documented in the case file.(d)
The Department must determine if the child or young adult has other insurance.(A)
All known or potential health insurance benefits or resources and all other third-party medical benefits, including casualty insurance available to the child or young adult, must be assigned to the Department.(B)
The form MSC 415H, “Notification of Other Health Insurance”, must be completed by a parent or the caseworker and sent to the Department for every child or young adult with health insurance coverage.(4)
Except when a child or young adult is determined eligible for Child Welfare Title XIX Medicaid under OAR 413-100-0435 (Title XIX Medicaid Eligibility for a Child or Young Adult Receiving Adoption Assistance or Guardianship Assistance), coverage ends the day the child or young adult leaves state custody, or enrolls into OCCS Medical.(5)
General Assistance coverage will be provided when a child or young adult in substitute care does not meet the eligibility requirements for Child Welfare Title XIX Medicaid coverage. Eligibility redeterminations for a child or young adult receiving General Assistance must be completed every 12 months.(6)
Redetermination of the eligibility of each child or young adult for Child Welfare Title XIX Medicaid must be reviewed every 12 months.(7)
Retroactive Title XIX Medicaid or General Assistance eligibility.(a)
A child or young adult receiving medical assistance through General Assistance rather than through Child Welfare Title XIX Medicaid due solely to the lack of a Social Security number (SSN) is eligible for Child Welfare Title XIX Medicaid retroactive to the date of placement once the Department receives verification of an application for an SSN from the Social Security Administration.(b)
A child or young adult in substitute care may be enrolled into Title XIX Medicaid or General Assistance retroactively to the date of initial placement, if not done on date of placement.(c)
A child or young adult who has been found to have dual prime numbers in the Medicaid Management Information System (MMIS) may receive retroactive coverage to the earliest date of coverage for either prime number.(8)
Corrections to the record of the child or young adult in the Department’s electronic information system may be made when it has been determined that the child or young adult was incorrectly shown as Child Welfare Title XIX Medicaid eligible for prior months.
Source:
Rule 413-100-0430 — Eligibility Determination for a Child or Young Adult in Substitute Care, https://secure.sos.state.or.us/oard/view.action?ruleNumber=413-100-0430.