Or. Admin. R. 461-135-0875 - Specific Requirements; Retroactive Eligibility
(1) Individuals are
evaluated for retroactive eligibility as follows:
(a) In the OSIPM programs, when individuals
received Medicaid-covered medical services prior to the date of request (see
OAR 461-115-0030). This includes
deceased individuals who would have been eligible for Medicaid covered services
had they, or someone acting on their behalf, applied.
(b) In the QMB-DW program, when individuals
paid or incurred Medicaid-covered Medicare Part A premiums, or were eligible
for but not enrolled in Medicare Part A prior to the date of request and
received Medicare Part A-covered services. This includes deceased individuals
who would have been eligible for Medicaid-covered premiums had they, or someone
acting on their behalf, applied.
(c) In the QMB-SMB and QMB-SMF programs, when
individuals paid or incurred Medicaid-covered Medicare Part B premiums, or were
eligible for but not enrolled in Medicare Part B prior to the date of request
and received Medicare Part B-covered services. This includes deceased
individuals who would have been eligible for Medicaid-covered premiums had
they, or someone acting on their behalf, applied.
(d) Individuals applying for medical
assistance through the REFM program are evaluated for retroactive
eligibility.
(2) If
eligible for medical assistance retroactively, the eligibility of the
individual may not start earlier than the date indicated by OAR
461-180-0140.
(3) In the QMB-BAS program, there are no
retroactive medical benefits.
Notes
Statutory/Other Authority: ORS 409.050, 411.060, 411.404, 413.085 & 414.685
Statutes/Other Implemented: 411.060, 411.404, 413.085, 414.685 & ORS 409.010
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.