OAR 461-135-0930
Medical Coverage for Refugees; REFM
(1)
Benefits in the REFM program are the same medical coverage as any Medicaid or CHIP program, except the QMB and CAWEM programs.(2)
An individual is not required to meet the financial eligibility criteria for the REFM program if the individual meets all the non-financial eligibility criteria for the REFM program and the requirements of at least one of the following subsections:(a)
The individual loses eligibility for any Medicaid or CHIP program, except the QMB and CAWEM programs, due to income from employment.(b)
The individual loses eligibility for any Medicaid or CHIP program, except the QMB and CAWEM programs, and is currently receiving benefits in the REF program.(c)
The individual had medical assistance established in another state based on refugee status granted by the United States Citizenship and Immigration Services, and:(A)
Moved to Oregon and is still within the individual’s first eight months in the United States; and(B)
Was found not eligible for any Medicaid or CHIP program other than the CAWEM and QMB programs.(3)
An individual who is determined eligible for the REFM program will maintain eligibility for the REFM program for the remainder of their first eight months in the United States even if the individual loses eligibility for the REF program due to having income equal to or over the countable (see OAR 461-001-0000 (Definitions for Chapter 461)) income and adjusted income (see OAR 461-001-0000 (Definitions for Chapter 461)) limits (see OAR 461-155-0030 (Income and Payment Standards; REF, TANF)).(4)
An individual applying for the REFM program is not required to apply for or receive benefits in the REF program.(5)
Except for the CAWEM and QMB programs, eligibility for all Medicaid and CHIP programs must be determined prior to determining eligibility for the REFM program.(6)
When a newborn is born to a member of a REFM program benefit group (see OAR 461-110-0750 (Benefit Group)):(a)
Members of the benefit group, may continue to receive REFM program benefits for the remainder of the eight months, as stated in OAR 461-135-0900 (Specific Requirements; REF, REFM)(4), if the member is determined ineligible for all Medicaid and CHIP programs.(b)
The newborn may receive REFM program benefits for the remainder of the eight months of the benefit group, if the newborn is determined ineligible for all Medicaid and CHIP programs.(7)
To be eligible for the REFM program, an individual may not be enrolled in Medicare.
Source:
Rule 461-135-0930 — Medical Coverage for Refugees; REFM, https://secure.sos.state.or.us/oard/view.action?ruleNumber=461-135-0930.