Or. Admin. Code § 410-115-0015

Current through Register Vol. 63, No. 11, November 1, 2024

Section 410-115-0015 - Eligibility and Enrollment

(1) Eligibility requirements for OHP Bridge - Basic Medicaid and OHP Bridge - Basic Health Program are described in OAR 410-200-0437 and in OAR 410-200-0438.

(2) Effective start dates for OHP Bridge - Basic Medicaid and OHP Bridge - Basic Health Program coverage are established in OAR 410-200-0115.

(3) In the event OHP Bridge coverage is incorrectly terminated or denied due to agency error, coverage shall commence or be reinstated as follows:

(a) If incorrectly denied due to agency error, the individual's enrollment in OHP Bridge and their benefit coverage shall begin on the first day of the month in which benefits may have been effective had the Authority not erred in its initial determination; or

(b) If incorrectly terminated due to agency error, the individual's OHP Bridge coverage shall be reinstated with no gap in coverage.

(4) OHP Bridge is not subject to any restricted application and enrollment period. Individuals have the right to apply to OHP Bridge at any time and, if determined eligible by the agency as set forth in this Division, be enrolled in OHP Bridge in accordance with this rule.

(5) Applicants who are determined to be ineligible for OHP Bridge have the right to appeal the determination in accordance with OAR Chapter 410, Division 141. If, on appeal, the applicant is determined to be eligible for OHP Bridge, eligibility shall be effective in accordance with section (3)(a) of this rule.

(6) Eligibility for OHP Bridge - Basic Health Program is evaluated for renewal every twelve (12) months.

(7) Eligibility for OHP Bridge - Basic Medicaid is evaluated for renewal as described in OAR 410-200-0115.

Or. Admin. Code § 410-115-0015

DMAP 94-2024, adopt filed 05/29/2024, effective 6/1/2024

Statutory/Other Authority: ORS 411.402, 411.404, 413.042, 414.241, 414.534, 42 CFR 433.138, 433.145-433.148, 435.3-435.4, 435.115-435.119, 435.170, 435.190, 435.222, 435.403, 435.940, 435.1200, 457.80, 457.340, 435.110, 458.350, 435.406-435.407, 435.952, 435.956, 435.1008, 457.320, 457.380, 435.608, 435.610, 435.916-435.917, 435.1205, 447.56, 457.350, 457.360, 457.805 & 600, 45 CFR 155.420 & 435.115

Statutes/Other Implemented: ORS 411.402, 411.404, 45 CFR 155.420, ORS 411.060, 411.095, 411.400, 411.406, 411.439, 411.443, 413.032, 413.038, 414.025, 414.231, 414.241, 414.440, 414.534, 414.536 & 414.706