Or. Admin. R. 461-180-0140 - Effective Dates; Retroactive Medical Benefits
(1) In the OSIPM program:
(a) If an applicant requests and is eligible
for retroactive medical benefits, the earliest date the applicant may be
eligible is the first day of the third month before the month that includes the
date of request (see OAR 461-115-0030). For example, if the applicant requests
benefits on July 10th, eligibility may begin as early as April 1.
(b) Except as provided for in subsections (c)
and (d) of this section, after the earliest date is established, eligibility is
determined on a month-by-month basis. The period starts on the earliest
established date and ends on the last day of the month prior to the month that
includes the date of request . For example, if the applicant requests benefits
on August 10th, the earliest date is May 1. Eligibility is established
separately for May 1 through May 31, June 1 through June 30, and July 1 through
July 31.
(c) Retroactive
eligibility is not available for any period that an individual is a
resident of a public institution (see OAR 461-135-0950) except
for the date of incarceration and the date of release, unless coverage would be
available under OAR 461-135-0950 while a resident of a public
institution.
(d) The
earliest effective date of retroactive eligibility for an individual who was
receiving medical benefits in another state during the retroactive period is
the day following the date that benefits end in the other state.
(2) If an applicant requests and
is eligible for retroactive QMB DW, the earliest date the applicant may be
eligible is three months before the date of request .
(3) If a QMB-SMB or QMB-SMF applicant
requests and is eligible for retroactive payment of Part B Medicare premiums,
the earliest date the applicant may be eligible is three months before the date
of request .
(4) If an applicant
applying for REFM is eligible for retroactive medical benefits, the earliest
the applicant may be eligible is the most recent of the following:
(a) The date the applicant arrived in the
United States; or
(b) Three months
before the date of request .
Notes
Statutory/Other Authority: ORS 409.050, 411.060 & 411.404
Statutes/Other Implemented: ORS 409.010, 411.060 & 411.404
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(1) In the OSIPM program:
(a) If an applicant requests and is eligible for retroactive medical benefits, the earliest date the applicant may be eligible is the first day of the third month before the month that includes the date of request (see OAR 461-115-0030). For example, if the applicant requests benefits on July 10th, eligibility may begin as early as April 1.
(b) Except as provided for in subsections (c) and (d) of this section, after the earliest date is established, eligibility is determined on a month-by-month basis. The period starts on the earliest established date and ends on the last day of the month prior to the month that includes the date of request. For example, if the applicant requests benefits on August 10th, the earliest date is May 1. Eligibility is established separately for May 1 through May 31, June 1 through June 30, and July 1 through July 31.
(c) Retroactive eligibility is not available for any period that an individual is a resident of a public institution (see OAR 461-135-0950) except for the date of incarceration and the date of release, unless coverage would be available under OAR 461-135-0950 while a resident of a public institution.
(d) The earliest effective date of retroactive eligibility for an individual who was receiving medical benefits in another state during the retroactive period is the day following the date that benefits end in the other state.
(2) If an applicant requests and is eligible for retroactive QMB DW, the earliest date the applicant may be eligible is three months before the date of request.
(3) If a QMB-SMB or QMB-SMF applicant requests and is eligible for retroactive payment of Part B Medicare premiums, the earliest date the applicant may be eligible is three months before the date of request.
(4) If an applicant applying for REFM is eligible for retroactive medical benefits, the earliest the applicant may be eligible is the most recent of the following:
(a) The date the applicant arrived in the United States; or
(b) Three months before the date of request.
Notes
Statutory/Other Authority: ORS 409.050, 411.060 & 411.404
Statutes/Other Implemented: ORS 409.010, 411.060 & 411.404