Or. Admin. Code § 413-100-0430 - Eligibility Determination for a Child or Young Adult in Substitute Care
Except as provided in OAR 413-100-0435(7), the following policies apply to a child or young adult in substitute care:
(1) Before a child or young
adult in substitute care may receive a medical card providing Child Welfare
Title XIX Medicaid services, the Department must determine the eligibility of
the child or young adult for Child Welfare Title XIX Medicaid.
(2) A child or young adult covered by OAR
413-100-0420 who meets one of
the following criteria is categorically eligible for Child Welfare Title XIX
Medicaid:
(a) Is eligible for Title IV-E
foster care payments; or
(b) Is
receiving Supplemental Security Income (SSI).
(3) As part of the eligibility determination
for Child Welfare Title XIX Medicaid:
(a) The
child or young adult must meet the citizenship and non-citizen status
requirements in OAR 413-100-0460.
(b) All income and resources will be
disregarded except as described in (3)(d) of this section.
(c) The child or young adult must have a
verified Social Security number (SSN) or verification that an application for
an SSN has been made and is documented in the case file.
(d) The Department must determine if the
child or young adult has other insurance.
(A)
All known or potential health insurance benefits or resources and all other
third-party medical benefits, including casualty insurance available to the
child or young adult, must be assigned to the Department.
(B) The form MSC 415H, "Notification of Other
Health Insurance", must be completed by a parent or the caseworker and sent to
the Department for every child or young adult with health insurance
coverage.
(4)
Except when a child or young adult is determined eligible for Child Welfare
Title XIX Medicaid under OAR
413-100-0435, coverage ends the
day the child or young adult leaves state custody, or enrolls into OCCS
Medical.
(5) General Assistance
coverage will be provided when a child or young adult in substitute care does
not meet the eligibility requirements for Child Welfare Title XIX Medicaid
coverage. Eligibility redeterminations for a child or young adult receiving
General Assistance must be completed every 12 months.
(6) Redetermination of the eligibility of
each child or young adult for Child Welfare Title XIX Medicaid must be reviewed
every 12 months.
(7) Retroactive
Title XIX Medicaid or General Assistance eligibility.
(a) A child or young adult receiving medical
assistance through General Assistance rather than through Child Welfare Title
XIX Medicaid due solely to the lack of a Social Security number (SSN) is
eligible for Child Welfare Title XIX Medicaid retroactive to the date of
placement once the Department receives verification of an application for an
SSN from the Social Security Administration.
(b) A child or young adult in substitute care
may be enrolled into Title XIX Medicaid or General Assistance retroactively to
the date of initial placement, if not done on date of placement.
(c) A child or young adult who has been found
to have dual prime numbers in the Medicaid Management Information System (MMIS)
may receive retroactive coverage to the earliest date of coverage for either
prime number.
(8)
Corrections to the record of the child or young adult in the Department's
electronic information system may be made when it has been determined that the
child or young adult was incorrectly shown as Child Welfare Title XIX Medicaid
eligible for prior months.
Notes
Statutory/Other Authority: ORS 418.005
Statutes/Other Implemented: ORS 418.005
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.