Department of Human Services
Self-Sufficiency Programs - Chapter 461
Division 120
GENERAL NONFINANCIAL ELIGIBILITY REQUIREMENTS
461-120-0345
Requirement to Obtain Health Care Coverage and Cash Medical Support; OSIPM, QMB
This rule explains the obligation of individuals applying for or receiving benefits under the OSIPM or QMB programs to obtain health care coverage and cash medical support for any individual receiving Medicaid under the state plan for which the individual can legally assign rights (see OAR 461-120-0310).
(1) Unless excused from the requirements of subsection (c) of this section or for good cause defined in OAR 461-120-0350:
(a) Individuals must cooperate with the Department and the Division of Child Support of the Department of Justice in establishing the identity of the parents (see OAR 461-001-0000) of any child (see OAR 461-001-0000) receiving Medicaid under the state plan for which the individual can legally assign rights.
(b) Individuals must cooperate with obtaining cash medical support.
(c) The Department may not refer a case for medical support enforcement when the referral is based solely on health care services provided through an Indian Health Program to a child who is eligible for health care services from the Indian Health Service.
(2) To be eligible for the OSIPM program, once informed of the requirement, an individual who is able to must apply for, accept, and maintain cost-effective, employer-sponsored health insurance (see OAR 461-155-0360). The individual is not required to incur a cost for the health insurance.
(3) An individual who fails to meet an applicable requirement in sections (1) or (2) of this rule is ineligible.
(a) In the case of an individual failing to meet the requirements of section (1) of this rule, the Department shall deny or close program benefits after providing the individual with notice and an opportunity to show good cause (see OAR 461-120-0350).
(b) The loss of eligibility does not apply to individuals who are not legally able to assign rights on behalf of themselves.
Statutory/Other Authority: ORS 411.060, 411.070, 412.024, 412.049 & 414.042
Statutes/Other Implemented: ORS 411.060, 411.070, 412.001, 412.024, 412.049, 414.025, 414.042, 42 CFR 433.147 & 42 CFR 435.610
History:
SSP 50-2022, amend filed 09/30/2022, effective 10/01/2022
SSP 42-2022, temporary amend filed 07/18/2022, effective 07/18/2022 through 01/13/2023
SSP 26-2019, amend filed 12/27/2019, effective 01/01/2020
SSP 14-2017, f. 6-5-17, cert. ef. 7-1-17
SSP 44-2016, f. 12-7-16, cert. ef. 1-1-17
SSP 31-2016, f. & cert. ef. 9-1-16
SSP 25-2016(Temp), f. 6-30-16, cert. ef. 7-1-16 thru 12-27-16
SSP 38-2013, f. 12-31-13, cert. ef. 1-1-14
SSP 30-2013(Temp), f. & cert. ef. 10-1-13 thru 3-30-14
SSP 38-2009, f. 12-31-09, cert. ef. 1-1-10
SSP 29-2009(Temp), f. & cert. ef. 10-1-09 thru 3-30-10
SSP 5-2008, f. 2-29-08, cert. ef. 3-1-08
SSP 11-2007(Temp), f. & cert. ef. 10-1-07 thru 3-29-08
SSP 17-2004, f. & cert. ef. 7-1-04
SSP 6-2004, f. & cert. ef. 4-1-04
SSP 35-2003(Temp), f. 12-31-03 cert. ef. 1-1-04 thru 3-31-04
SSP 33-2003, f. 12-31-03, cert. ef. 1-4-04
SSP 29-2003(Temp), f. 10-31-03, cert. ef. 11-1-03 thru 3-31-04
SSP 16-2003, f. & cert. ef. 7-1-03
SSP 1-2003, f. 1-31-03, cert. ef. 2-1-03
AFS 13-2002, f. & cert. ef. 10-1-02
AFS 27-2001, f. 12-21-01, cert. ef. 1-1-02
AFS 19-2001, f. 8-31-01, cert. ef. 9-1-01
AFS 17-2000, f. 6-28-00, cert. ef. 7-1-00
AFS 1-2000, f. 1-13-00, cert. ef. 2-1-00
AFS 10-1998, f. 6-29-98, cert. ef. 7-1-98
AFS 24-1997, f. 12-31-97, cert. ef. 1-1-98
AFS 19-1997, f. & cert. ef. 10-1-97
AFS 3-1997, f. 3-31-97, cert. ef. 4-1-97
AFS 30-1996, f. & cert. ef. 9-23-96
AFS 10-1995, f. 3-30-95, cert. ef. 4-1-95
AFS 2-1994, f. & cert. ef. 2-1-94
AFS 19-1993, f. & cert. ef. 10-1-93
AFS 28-1992, f. & cert. ef. 10-1-92