Or. Admin. R. 461-135-0930 - Medical Coverage for Refugees; REFM

Current through Register Vol. 61, No. 4, April 1, 2022

(1) Benefits in the REFM program are the same medical coverage as any Medicaid or CHIP program, except the QMB and CWM programs.
(2) An individual is not required to meet the financial eligibility criteria for the REFM program if the individual meets all the non-financial eligibility criteria for the REFM program and the requirements of at least one of the following subsections:
(a) The individual loses eligibility for any Medicaid or CHIP program, except the QMB and CWM programs, due to income from employment.
(b) The individual loses eligibility for any Medicaid or CHIP program, except the QMB and CWM programs, and is currently receiving benefits in the REF program.
(c) The individual had medical assistance established in another state based on refugee status granted by the United States Citizenship and Immigration Services, and:
(A) Moved to Oregon and is still within the individual's first eight months in the United States; and
(B) Was found not eligible for any Medicaid or CHIP program other than the CWM and QMB programs.
(3) An individual who is determined eligible for the REFM program will maintain eligibility for the REFM program for the remainder of their first eight months in the United States even if the individual loses eligibility for the REF program due to having income equal to or over the countable (see OAR 461-001-0000) income and adjusted income (see OAR 461-001-0000) limits (see OAR 461-155-0030).
(4) An individual applying for the REFM program is not required to apply for or receive benefits in the REF program.
(5) Except for the CWM and QMB programs, eligibility for all Medicaid and CHIP programs must be determined prior to determining eligibility for the REFM program.
(6) When a newborn is born to a member of a REFM program benefit group (see OAR 461-110-0750):
(a) Members of the benefit group, may continue to receive REFM program benefits for the remainder of the eight months, as stated in OAR 461-135-0900(4), if the member is determined ineligible for all Medicaid and CHIP programs.
(b) The newborn may receive REFM program benefits for the remainder of the eight months of the benefit group, if the newborn is determined ineligible for all Medicaid and CHIP programs.
(7) To be eligible for the REFM program, an individual may not be enrolled in Medicare.

Notes

Or. Admin. R. 461-135-0930
AFS 80-1989, f. 12-21-89, cert. ef. 2-1-90; AFS 20-1990, f. 8-17-90, cert. ef. 9-1-90; AFS 10-1995, f. 3-30-95, cert. ef. 4-1-95; AFS 13-1995, f. 6-29-95, cert. ef. 7-1-95; AFS 15-1999, f. 11-30-99, cert. ef. 12-1-99; SSP 23-2008, f. & cert. ef. 10-1-08; SSP 24-2013, f. & cert. ef. 10-1-13; SSP 30-2013(Temp), f. & cert. ef. 10-1-13 thru 3-30-14; SSP 38-2013, f. 12-31-13, cert. ef. 1-1-14; SSP 10-2017, f. 3-24-17, cert. ef. 4/1/2017; SSP 22-2017, f. 9-8-17 & cert. ef. 10/1/2017; SSP 29-2021, temporary amend filed 03/29/2021, effective 3/29/2021 through 9/24/2021; SSP 33-2021, amend filed 06/22/2021, effective 7/1/2021; SSP 21-2022, minor correction filed 02/16/2022, effective 2/16/2022

Statutory/Other Authority: ORS 409.050, 411.060, 411.404, 413.085 & 414.685

Statutes/Other Implemented: ORS 409.010, 411.060 & 411.404

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