Or. Admin. Code § 410-200-0436

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

Section 410-200-0436 - [Effective until 11/17/2024] Specific Requirements: MAGI Expanded Adult Program

(1) The Modified Adjusted Gross Income (MAGI) Expanded Adult program is effective April 1, 2023

(2) Notwithstanding any other rule to the contrary in these Chapter 410, Division 200 rules, the MAGI Expanded Adult Program shall be closed to new enrollment effective July 1, 2024. Beginning in June 2024, eligibility for MAGI Expanded Adult Program recipients shall be redetermined, and:

(a) If determined eligible for any OHP Plus program shall be transitioned to that program,

(b) If determined eligible for a medical program that provides reduced benefits, including an OHP Bridge program, shall be transitioned to that program, with timely notice as described in OAR 410-200-0015 (32)(c).

(c) If determined ineligible for any medical assistance program, shall be terminated with timely notice as described in OAR 410-200-0521 (8)

(3) Individuals who lose eligibility for other OHP Plus medical benefits due to an increase of countable income may be eligible for the MAGI Expanded Adult program if they:

(a) Are 19 years of age or older and under age 65;

(b) Have household income greater than 138 percent federal poverty level through 200 percent federal poverty level (OAR 410-200-0315) for the applicable family size;

(c) Meet citizenship or non-citizen status requirements outlined in OAR 410-200-0215;

(d) Are not entitled to or enrolled in Medicare benefits under part A or B of Title XVIII of the Act; and

(e) Are not receiving SSI benefits.

(4) As a condition of MAGI Expanded Adult program eligibility for parents or caretaker relatives with a dependent child living in the home, the child must be enrolled in minimum essential coverage.

(5) The MAGI Expanded Adult program is not available to new applicants or individuals reapplying after a break in coverage.

(6) The MAGI Expanded Adult program is not subject to protected eligibility provisions related to pregnancy, described in OAR 410-200-0135 - Assumed, Continuous, and Protected Eligibility for Children and Pregnant Individuals section (3).

(7) The MAGI Expanded Adult program eligibility is not subject to the pursuit of assets requirements found in OAR 410-200-0220 - Requirement to Pursue Assets.

Or. Admin. Code § 410-200-0436

DMAP 11-2023, adopt filed 03/30/2023, effective 4/1/2023; DMAP 90-2024, temporary amend filed 05/22/2024, effective 5/22/2024 through 11/17/2024

Statutory/Other Authority: 42 CFR 435.110, ORS 435.112, 435.115, 435.116, 435.118, 435.403, 435.940, 435.1200, 457.80, 457.340, 458.350, 435.3, 435.4, 435.406, 435.407, 435.952, 435.956, 435.1008, 457.320, 457.380, 435.608, 433.138, 433.145, 433.146, 433.147, 433.148, 435.117, 435.119, 435.1205, 435.170, 435.190, 435.222, 435.610, 435.916, 435.917, 447.56, 457.350, 457.360, 457.805, ORS 411.402, 411.404, 413.042 & 414.534

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