Oregon Department of Human Services, Self-Sufficiency Programs

Rule Rule 461-135-0875
Specific Requirements; Retroactive Eligibility

(1)

Individuals are evaluated for retroactive eligibility as follows:

(a)

In the OSIPM program, when individuals received Medicaid-covered medical services prior to the date of request (see OAR 461-115-0030 (Date of Request)). This includes deceased individuals who would have been eligible for Medicaid covered services had they, or someone acting on their behalf, applied.

(b)

In the QMB-DW program, when individuals paid or incurred Medicaid-covered Medicare Part A premiums, or were eligible for but not enrolled in Medicare Part A prior to the date of request and received Medicare Part A-covered services. This includes deceased individuals who would have been eligible for Medicaid-covered premiums had they, or someone acting on their behalf, applied.

(c)

In the QMB-SMB and QMB-SMF programs, when individuals paid or incurred Medicaid-covered Medicare Part B premiums, or were eligible for but not enrolled in Medicare Part B prior to the date of request and received Medicare Part B-covered services. This includes deceased individuals who would have been eligible for Medicaid-covered premiums had they, or someone acting on their behalf, applied.

(d)

Individuals applying for medical assistance through the REFM program are evaluated for retroactive eligibility.

(e)

Individuals found ineligible for the OSIPM program solely because they do not meet the citizenship requirements of OAR 461-120-0125 (Alien Status). Individuals eligible under this subsection are eligible only for CAWEM program benefits (see OAR 461-135-1070 (Specific Requirements; Citizen/Alien-Waived Emergent Medical (CAWEM))).

(2)

If eligible for medical assistance retroactively, the eligibility of the individual may not start earlier than the date indicated by OAR 461-180-0140 (Effective Dates; Retroactive Medical Benefits).

(3)

In the QMB-BAS program, there are no retroactive medical benefits.
Source

Last accessed
Jun. 8, 2021

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