Oregon Department of Human Services, Self-Sufficiency Programs

Rule Rule 461-180-0140
Effective Dates; Retroactive Medical Benefits


(1)

In the OSIPM program:

(a)

If an applicant requests and is eligible for retroactive medical benefits, the earliest date the applicant may be eligible is the first day of the third month before the month that includes the date of request (see OAR 461-115-0030 (Date of Request)). For example, if the applicant requests benefits on July 10th, eligibility may begin as early as April 1.

(b)

Except as provided for in subsections (c) and (d) of this section, after the earliest date is established, eligibility is determined on a month-by-month basis. The period starts on the earliest established date and ends on the last day of the month prior to the month that includes the date of request. For example, if the applicant requests benefits on August 10th, the earliest date is May 1. Eligibility is established separately for May 1 through May 31, June 1 through June 30, and July 1 through July 31.

(c)

Retroactive eligibility is not available for any period that an individual is an inmate (see OAR 461-135-0950 (Eligibility for Inmates and Residents of Public Institutions)) except for the date of incarceration and the date of release, unless coverage would be available under OAR 461-135-0950 (Eligibility for Inmates and Residents of Public Institutions) while an inmate.

(d)

The earliest effective date of retroactive eligibility for an individual who was receiving medical benefits in another state during the retroactive period is the day following the date that benefits end in the other state.

(2)

If an applicant requests and is eligible for retroactive QMB DW, the earliest date the applicant may be eligible is three months before the date of request.

(3)

If a QMB-SMB or QMB-SMF applicant requests and is eligible for retroactive payment of Part B Medicare premiums, the earliest date the applicant may be eligible is three months before the date of request.

(4)

If an applicant applying for REFM is eligible for retroactive medical benefits, the earliest the applicant may be eligible is the most recent of the following:

(a)

The date the applicant arrived in the United States; or

(b)

Three months before the date of request.
Source

Last accessed
Jun. 8, 2021