Or. Admin. Code § 410-200-0438

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

Section 410-200-0438 - Specific Requirements: OHP Bridge - Basic Health Program

In addition to the general requirements applicable to OHP Bridge - Basic Health Program set forth in this Division 200, this rule describes specific eligibility requirements for OHP Bridge - Basic Health Program.

(1) OHP Bridge - Basic Health Program is effective on July 1, 2024.

(2) To be eligible for OHP Bridge - Basic Health Program an individual must:

(a) Be age 19 or older and under age 65;

(b) Have, as required under OAR 410-200-0315, monthly MAGI-based income which exceeds 133 percent of the federal poverty level (FPL) for the applicable family size; have annual household income for the applicable family size up to and including 200 percent FPL for the coverage year being requested; and

(c) Meet citizenship status requirements outlined in OAR 410-200-0215(1), or non-citizen status requirements outlined in OAR 410-200-0215(5).

(3) Even if an individual meets the requirements in section (2) of this rule, the individual shall not be eligible for OHP Bridge - Basic Health Program if they:

(a) Are enrolled in Medicare benefits under part A or B of Title XVIII of the Act; or

(b) Are receiving other healthcare coverage that qualifies as Minimum Essential Coverage as defined in OAR 410-200-0015(55), unless that coverage is an Insurance Affordability Program as defined in OAR 410-200-0015(50); or

(c) Are able to access affordable coverage as described in section 36B(c)(2)(C)(i)(II) of the IRS Code and 26 CFR section 1.36B-2(c)(3)(v)(A) (1). The required contribution percentage is indexed annually under section 26 U.S.C. 36B(c)(2)(C)(iv); or

(d) Are receiving Supplemental Security Income (SSI) benefits.

(4) OHP Bridge - Basic Health Program eligibility is re-evaluated every twelve (12) months.

(5) An individual who is approved for OHP Bridge - Basic Health Program coverage is entitled to twelve (12) months of coverage provided they continue to meet non-financial eligibility criteria. Once approved, an individual's OHP Bridge - Basic Health Program coverage shall not be terminated during a twelve (12) month eligibility period due to an increase of countable income.

Or. Admin. Code § 410-200-0438

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, 435.110, 435.115-435.119, 435.190, 435.222, 435.403, 435.406-435.407, 435.608, 435.610, 435.916-435.917, 435.940, 435.952, 435.956, 435.1008, 435.1200, 435.1205, 447.56, 457.80, 457.320, 457.340, 457.350, 457.360, 457.380, 457.805, 458.350, 435.112 & 435.170

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