Oregon Department of Human Services, Self-Sufficiency Programs

Rule Rule 461-120-0345
Clients Required to Obtain Health Care Coverage and Cash Medical Support; OSIPM, QMB


This rule explains the obligation of individuals applying for or receiving benefits under the OSIPM or QMB programs to obtain health care coverage and cash medical support for any individual receiving Medicaid under the state plan for which the individual can legally assign rights (see OAR 461-120-0310 (Assignment of Support Rights; Not SNAP)).

(1)

Unless excused from the requirements of subsection (d) of this section or for good cause defined in OAR 461-120-0350 (Individuals Excused for Good Cause from Compliance with Requirements to Pursue Child Support, Health Care Coverage, and Medical Support):

(a)

Individuals must cooperate with the Department and the Division of Child Support of the Department of Justice in establishing the identity of the parents (see OAR 461-001-0000 (Definitions for Chapter 461)) of any child (see OAR 461-001-0000 (Definitions for Chapter 461)) receiving Medicaid under the state plan for which the individual can legally assign rights.

(b)

Individuals must cooperate with obtaining cash medical support.

(c)

Each individual must make a good faith effort to obtain available coverage under Medicare. In the OSIPM program, the applicant is not required to enroll in Medicare Part A coverage if all of the following are true:

(A)

The applicant will incur a cost for the coverage.

(B)

The applicant is otherwise ineligible for QMB-BAS.

(C)

The applicant does not have a service liability in excess of the Part A premium.

(d)

The Department may not refer a case for medical support enforcement when the referral is based solely on health care services provided through an Indian Health Program to a child who is eligible for health care services from the Indian Health Service.

(2)

Each individual must make a good faith effort to obtain available coverage under Tri-Care.

(3)

To be eligible for the OSIPM program, once informed of the requirement, an individual who is able to must apply for, accept, and maintain cost-effective, employer-sponsored health insurance (see OAR 461-155-0360 (Pursuit of Cost-Effective Employer Sponsored Health Insurance)). The individual is not required to incur a cost for the health insurance.

(4)

An individual who fails to meet an applicable requirement in sections (1), (2), or (3) of this rule is ineligible.

(5)

In the case of an individual failing to meet the requirements of section (1) of this rule, the Department applies the penalty after providing the client with notice and opportunity to show the provisions of OAR 461-120-0350 (Individuals Excused for Good Cause from Compliance with Requirements to Pursue Child Support, Health Care Coverage, and Medical Support) apply.

(6)

The penalty provided by this rule ends when the individual meets the requirements of this rule.

(7)

The penalty does not apply to individuals who are not legally able to assign rights on behalf of themselves.
Source

Last accessed
Jun. 8, 2021