Or. Admin. R. 410-200-0220 - Requirement to Pursue Assets

(1) 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)).
(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 (410-200-0240) or during a period of Hospital Presumptive Eligibility (410-200-0105):
(a) 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;
(b) Each applicant, including a parent for their child, shall make a good faith effort to obtain available coverage under Medicare, if it is available.
(c) HSD Medical Program beneficiaries described in this section, including a parent for their child, shall apply for, accept, and maintain cost-effective employer-sponsored health insurance unless they have good cause (see section (6) of this rule):
(A) The Health Insurance Group (HIG) determines if employer sponsored health insurance meets the criteria to be considered cost effective; and
(B) If the insurance is determined to be cost effective and the individual pursues the insurance, HIG will authorize reimbursement of the individual's portion of the premium per OAR 410-120-1960.
(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 would 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 would result;
(b) For individuals with the authority to pursue child support on behalf of a child who is applying for or receiving Medicaid/CHIP 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 would 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.


Or. Admin. R. 410-200-0220
DMAP 54-2013(Temp), f. & cert. ef. 10-1-13 thru 3-30-14; DMAP 4-2014(Temp), f. & cert. ef. 1-15-14 thru 3-30-14; DMAP 20-2014, f. & cert. ef. 3-28-14; DMAP 67-2014(Temp), f. 11-14-14, cert. ef. 11-15-14 thru 5-13-15; DMAP 3-2015, f. & cert. ef. 1/30/2015; DMAP 23-2020, amend filed 05/07/2020, effective 5/8/2020

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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