461-135-0875 Effective 10/01/17
Specific Requirements; Retroactive Eligibility
- Individuals are evaluated for retroactive eligibility as follows:
- In the OSIPM program, 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.
- 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.
- 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.
- Individuals applying for medical assistance through the REFM program are evaluated for retroactive eligibility.
- Individuals found ineligible for the OSIPM program solely because they do not meet the citizenship requirements of OAR 461-120-0125. Individuals eligible under this subsection are eligible only for CAWEM program benefits (see OAR 461-135-1070).
- If eligible for medical assistance retroactively, the eligibility of the individual may not start earlier than the date indicated by OAR 461-180-0140.
- In the QMB-BAS program, there are no retroactive medical benefits.
Stat. Auth.: ORS 409.050, 411.060, 411.404, 413.085, 414.685
Stats. Implemented: ORS 409.010, 411.060, 411.404, 413.085, 414.685