461-115-0705 Effective 04/01/12
Required Verification; BCCM, EXT, HKC, MAA, MAF, OHP, SAC
- This rule establishes verification requirements for the BCCM, EXT, HKC, MAA, MAF, OHP, and SAC programs in addition to the requirements of OAR 461-115-0610.
- Except as provided in section (3) of this rule, each client declaring U.S. citizenship must provide acceptable documentation of citizenship and identity. For purposes of this rule, acceptable documentation consists of any of the documents permitted under section 1903(x) of the Social Security Act (42 U.S.C. 1396b).
- A new applicant must provide acceptable documentation as a condition of eligibility (see OAR 461-001-0000). Except for an applicant whose medical benefits previously were closed after March 31, 2009 for not providing acceptable documentation, an applicant's medical assistance may not be delayed for citizenship documentation while the eligibility decision is pending if all other medical assistance eligibility requirements have been met.
- A current recipient who has not already provided acceptable documentation must provide acceptable documentation as a condition of eligibility when requested by the Department.
- A client who already has provided acceptable documentation is not required to provide additional evidence during a subsequent application for benefits or redetermination of eligibility.
- Each of the following clients is exempt from the requirements of section (2) of this rule, a client who is:
- Assumed eligible under OAR 461-135-0010(5);
- Eligible for or receiving Medicare;
- Presumptively eligible for the BCCM program;
- Receiving Social Security Disability Income (SSDI); or
- Receiving Title IV-E benefits.
- At initial application and at any other time it affects the client, the following must be verified:
- The requirement in OAR 461-120-0210 to have or apply for a social security number.
- Alien status for an applicant who indicates he or she is not a U.S. citizen, and for a client who meets the alien status requirement under OAR 461-120-0125(4)(b) the client's alien status must be verified at each certification.
- When the pregnancy of a client is first reported, it must be verified by a medical practitioner, health department, clinic, or crisis pregnancy center or similar facility.
- In the HKC, MAA, MAF, OHP, and SAC programs, at initial application, recertification, and at any other time it affects the client, the Department must verify the client's statement of income. If no verification is available, the Department accepts the client's statement.
- In the OHP-OPU program, to allow a premium exemption, the Department must verify that a client is --
- A member of a federally recognized Indian tribe, band, or group;
- An Eskimo, Aleut, or other Alaska native enrolled by the Secretary of the Interior pursuant to the Alaska Native Claims Settlement Act; or
- An individual eligible for benefits through an Indian Health Program.
- In the EXT, MAA, MAF, OHP-OPC, and OHP-OP6 programs, the amount of the premium for cost-effective employer-sponsored health insurance must be verified.
- A client must provide verification for any eligibility requirement in sections (4) to (8) of this rule questioned by the Department.
Stat. Auth.: ORS 409.050, 411.060, 411.070, 411.404, 414.231
Stats. Implemented: ORS 409.010, 411.060, 411.070, 411.400, 411.404, 414.025, 414.231, 414.428, 414.826, 414.831, 414.839