OAR 461-180-0010
Effective Dates; Adding a New Person to an Open Case
(1)
In the following programs, the effective date for adding an individual (other than an assumed eligible newborn) to the benefit group (see OAR 461-110-0750 (Benefit Group)) is one of the following:(a)
In the OSIPM program, the date benefits are requested for the individual establishes a date of request (see OAR 461-115-0030 (Date of Request)) for the individual. The effective date for the individual is determined in accordance with OAR 461-180-0090 (Effective Dates; Initial Month Medical Benefits).(b)
In the REFM program, it is whichever occurs first:(A)
The date the individual requests benefits, if the individual was eligible as of that date.(B)
The date all eligibility requirements are met.(c)
In the SNAP program:(A)
If adding the individual increases benefits, it is the first of the month after the filing group (see OAR 461-110-0310 (Filing Group; Overview) and 461-110-0370 (Filing Group; SNAP)) reports the person has joined the household group (see OAR 461-110-0210 (Household Group)). If verification is requested, the effective date for the change is:(i)
The first of the month following the date the change was reported if verification is received by the Department no later than the due date for the verification.(ii)
The first of the month following the date the verification is received by the Department if received after the verification due date.(B)
If adding the individual reduces benefits, it is the first of the month following the month in which the notice period ends (see OAR 461-175-0050 (Notice Period)).(d)
In the GA, OSIP, REF, SFPSS, and TANF programs, it is the date on which all eligibility requirements are met and verified. If benefits have been issued for the month and adding the new person would reduce benefits, the person is added the first of the month following the month in which the notice period ends (see OAR 461-175-0050 (Notice Period)).(e)
In the QMB-BAS and QMB-DW programs, it is the first of the month after the new individual has been determined to meet all QMB eligibility criteria and the Department receives the required verification.(f)
In the QMB-SMB program, it is the first of the month in which the new individual has been determined to meet all QMB-SMB eligibility criteria and the Department receives the required verification.(g)
In the SFPSS, TA-DVS, and TANF programs, for adding a child (see OAR 461-001-0000 (Definitions for Chapter 461)) to be covered by a provider-direct child care payment, it is the first of the month in which the child is added to the benefit group.(2)
In the following programs, the effective date for adding an assumed eligible newborn to the benefit group is one of the following:(a)
In the OSIPM and REFM programs, it is the date of birth if all the following paragraphs are true. If any of the following paragraphs is not true, the newborn is added to the benefit group in accordance with section (1) of this rule.(A)
A request for benefits is made within one year of the birth. For purposes of this paragraph, a telephone call from the attending physician, another licensed practitioner, a hospital, or the family is considered a request for benefits.(B)
The newborn has continuously lived with the mother since the date of birth.(C)
The mother was receiving OSIPM on the date of birth, even if she is not currently eligible for benefits.(b)
In the SFPSS and TANF programs, it is:(A)
The date of birth, if all eligibility requirements are met and verified within 30 days after the birth; or(B)
The date all eligibility factors are met and verified, if the verification is completed more than 30 days after the date of birth.(3)
In the ERDC program, the effective date for adding an individual to the need group (see OAR 461-110-0630 (Need Group)) or benefit group is as follows:(a)
If adding the individual to the need group will decrease the copay, the effective date is the first of the month after the client reports the person has joined the household.(b)
If adding the individual to the need group increases the copay, for instance, because the individual receives income, the effective date is the first of the month following the end of the decision notice period (see OAR 461-175-0050 (Notice Period)).(c)
The effective date for adding a child to the benefit group, that is, covering the cost of the child’s care, is the earliest of the following:(A)
For newborns, the date of birth, if all eligibility requirements are met and verified within 45 days after the birth.(B)
For all other children, the first of the month in which the change is reported, if all eligibility requirements are met and verified within 45 days.(C)
For newborns and other children, if eligibility cannot be verified within 45 days, the effective date is the first of the month in which all eligibility factors are met and verified.
Source:
Rule 461-180-0010 — Effective Dates; Adding a New Person to an Open Case, https://secure.sos.state.or.us/oard/view.action?ruleNumber=461-180-0010.