Or. Admin. R. 410-200-0220 - Requirement to Pursue Assets
(1) For all HSD
Medical Programs except for OHP Bridge- Basic Health Program, as a condition of
ongoing eligibility, an applicant or beneficiary shall make a good faith effort
to obtain an asset to which they have a legal right or claim, except an
applicant or beneficiary is not required to:
(a) Apply for Supplemental Security Income
(SSI) from the Social Security Administration;
(b) Borrow money;
(c) Pursue an asset if the individual can
show good cause for not doing so (see section (6) of this rule).
(2) For all HSD Medical Programs,
pursuable assets include but are not limited to:
(a) Claims related to an injury;
(b) Disability benefits;
(c) Healthcare coverage;
(d) Retirement benefits;
(e) Survivorship benefits (including
inheritance, devise or elective share);
(f) Discretionary or mandatory distribution
from a trust;
(g) Unemployment
compensation; and
(h) Veteran's
compensation and pensions.
(3) For all HSD Medical Programs except MAGI
CHIP and eligibility granted under Cover All Kids (OAR 410-200-0240) or during
a period of Hospital Presumptive Eligibility (OAR 410-200-0105), Each caretaker
in the EDG shall assist the Agency and the Division of Child Support (DCS) in
establishing paternity for each child receiving medical assistance and in
obtaining an order directing the non-custodial parent of a child receiving
benefits to provide cash medical support and health care coverage for that
child;
(4) An individual involved
in a personal injury shall pursue a claim for the personal injury. If the claim
or action to enforce such claim was initiated prior to the application for
medical assistance, the individual shall notify the Agency during the
eligibility verification process (OAR 410-200-0230). The following information
is required:
(a) The names and addresses of
all parties against whom the action is brought or claim is made;
(b) A copy of each claim demand;
and
(c) If an action is brought,
the case number and the county where the action is filed.
(5) Except as outlined in section (6) of this
rule, a caretaker who has the authority to pursue an asset on behalf of a child
applying for or receiving Medicaid/CHIP and fails to do so is ineligible for
assistance. The child's eligibility is not impacted by the caretaker's failure
to pursue an asset on their behalf.
(6) The requirement for an individual to
pursue an asset does not apply when good cause exists. An individual is
considered to have good cause if any of the following are true:
(a) Pursuing the asset may result in
emotional or physical harm to the dependent child or to the caretaker. The
statement of the caretaker serves as prima facie evidence that harm may
result;
(b) For individuals with
the authority to pursue child support on behalf of a child who is applying for
or receiving Medicaid benefits, the individual is considered to have good cause
if:
(A) The child was conceived as a result of
incest or rape and efforts to obtain support may be detrimental to the
dependent child. The statement of the caretaker serves as prima facie evidence
on the issues of conception and detrimental effect to the dependent
child;
(B) Legal proceedings are
pending for adoption of the child;
(C) The parent is being helped by a public or
licensed private social agency to resolve the issue of whether to release the
child for adoption;
(D) The
individual is pregnant; or
(E)
Other good cause reasons exist for non-cooperation.
(7) Unless specified otherwise in
this rule, an individual who fails to comply with the requirements of this rule
is ineligible for benefits until the individual meets the requirements of this
rule.
Notes
Statutory/Other Authority: ORS 411.402, 411.404 & 413.042
Statutes/Other Implemented: ORS 411.400, 411.402, 411.404, 411.406, 413.032, 414.025, 414.231 & 414.706
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