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OHP program manual

D. Nonfinancial Requirements

Effective 7/1/13

1. Residency

To be eligible for medical assistance, people must be residents of Oregon. They must be currently living in Oregon and intend to remain in the state. There is no requirement that they must have been in Oregon or intend to remain in the state for a minimum amount of time. Residents can leave the state for temporary purposes (e.g., vacation, school attendance, medical treatment, employment) and keep their residency as long as they intend to return to Oregon.

• Note: If a client is gone for more than 30 days, disenroll them from their managed care plans.

A new resident receiving medical assistance from another state may receive duplicate medical assistance from Oregon if the person would be eligible in Oregon and would not otherwise receive medical care. Medical benefits may be authorized for an eligible client if an Oregon provider refuses to bill another state and the client would not otherwise receive medical care.

Residency Requirements: 461-120-0010
Statement of Intent to Reside: 461-120-0050
Duplicate Benefits: 461-165-0030

State of Residence for People in a Medical Facility. Residency of an individual living in a state or private medical facility such as a hospital, mental hospital, nursing home, or convalescent center is determined as follows:

• An individual age 21 or older who is capable of indicating intent to reside is considered to be a resident of the state where the individual is living with the intention to remain permanently or for an indefinite period.
• An individual age 21 or older who became incapable of indicating intent to reside after age 21 is considered to be a resident of the state where the facility is located unless the individual was placed in the facility by a state agency of another state. When a state agency of another state places an individual, the individual is considered to be a resident of the state that makes the placement.
• For an individual under age 21 who is incapable of forming an intent to reside, or an individual of any age who became incapable of forming that intent before age 21, the state of residence is one of the following:
  • The state of residence of the individual's parent or legal guardian at the time of application.
  • The state of residence of the party who applies for benefits on his or her the individual's behalf, if there is no living parent, or the location of the parent is unknown, and there is no legal guardian.
  • Oregon, if the individual has been receiving medical assistance in Oregon continuously since November 1, 1981, or is from a state with which Oregon has an interstate agreement that waives the residency requirement.

461-120-0030

2. Citizen/Noncitizen Status

To be eligible for medical benefits, all applicants (except CAWEM applicants) must be a U.S. citizen or meet the alien status requirements. CAWEM applicants are not required to declare or provide proof of their citizenship or immigration status. Nonapplicants do not have to meet the citizenship or alien status requirement. Nonapplicants are not required to declare or provide proof of their citizenship or immigration status. The disclosure of information regarding citizenship and alien status for nonapplicants is voluntary.

• Note: Nonapplicants are persons who choose not to apply for benefits or who are not eligible to receive benefits, even though they may be required to provide verification of income and resources.

Medicaid clients must verify citizenship except some clients are considered to have met the U.S. citizenship documentation requirements already and do not need to provide evidence of citizenship:

• SSI recipients;
• Medicare recipients;
• SSDI recipients; and
• Assumed eligible newborns born in Oregon. Once determined to be an assumed eligible newborn born July 1, 2006 or later, the client is exempt from providing citizenship documentation. A new system code to track Oregon born AENs has been requested.

To be eligible for the CAWEM program, a client must be ineligible for MAA, MAF, OHP or OSIPM solely because they do not meet citizenship or alien status requirements.

To qualify for OHP, a person must be one of the following:

• A U.S. citizen, or
• A qualified noncitizen who was admitted into the U.S. before August 22, 1996.

A U.S. citizen includes the following:

• A person born in the U.S.
• A person born outside of the U.S. but whose parents (both mother and father) are U.S. citizens.
• A person born outside of the U.S., who is now over 18 years of age, but who has at least one parent who is a U.S. citizen. The person must either have a certificate of U.S. citizenship or meet one of the following criteria:
  • Born on or after 12/24/52 and prior to 11/14/86, and their citizen parent was physically present in the U.S. or its outlying possessions for 10 years or more, at least five of which were after age 14.
  • Born on or after 11/14/86, and their citizen parent was physically present in the U.S. or its outlying possessions five years or more, at least two of which were after age 14.
• A child born outside of the U.S. who is under 18 years of age and has at least one parent who is a U.S. citizen. The child is residing in the U.S. in the legal and physical custody of the citizen parent pursuant to a lawful admission for permanent residence.
• A person lawfully adopted by U.S. citizens.
• A citizen of Puerto Rico, Guam, the Virgin Islands, the Northern Mariana Islands (Saipan, Tinian, Rota and Pagan), American Samoa and the Swains Islands.

For information on sponsored noncitizens see the CAF Family Services Manual Section 9.

A qualified noncitizen meets the alien status requirement if they are one of the following:

• Qualified non-citizen under age 19;
• A person who was admitted as a qualified noncitizen on or before 8/22/96.
• A person who entered the U.S. on or after August 22, 1996 and it has been five years since he or she became a qualified noncitizen
• A person who has obtained their qualified noncitizen status less than five years ago but entered the U.S. prior to August 22, 1996. The noncitizen must show that he or she has been living in the U.S. continuously for five years from a date prior to 8/22/96 to the date the noncitizen obtained their qualified status. If the noncitizen cannot establish the five-year continuous residence before he or she obtained their qualified status, the person is not considered to have entered the U.S. prior to 8/22/96.

Regardless when they were admitted, a person with one of the following designated statuses:

• A person admitted as a refugee under section 207 of the INA (code REF).
• A person granted political asylum under section 208 of the INA (code ASY).
• A person whose deportation is withheld under section 243(h) of the INA (code DBW).
• A Cuban or Haitian entrant who is either a public interest or humanitarian parolee. (code CUH).
• A person granted immigration status according to the Foreign Operations Export Financing and Related Program Appropriation Act of 1988.
• Certain battered spouses and dependent children who are in the U.S. on a conditional resident status, as determined by INS (code BCR).

Regardless of when they were admitted, a qualified noncitizen who is:

• A veteran of the U.S. Armed Forces, who was honorably discharged not on account of alien status and who fulfills the minimum active-duty service requirement; or
• On active duty in the U.S. Armed Forces (other than active duty for training).
• The spouse or unmarried child of the veteran or person on active duty described above.

The following meet the alien status requirements:

• American Indians born in Canada to whom the provisions of section 289 of the Immigration and Nationality Act apply, and
• Members of an Indian tribe (as defined in the Indian Self-Determination and Education Act.

See the noncitizen chart in SPD Worker Guide D.1.

Citizen/Alien Requirements: 461-120-0110
Noncitizen status: 461-120-0125

All lawfully admitted aliens are given an INS document showing their legal status in the U.S. People who are lawful permanent residents are given an Alien Registration card (I-551). If they entered the U.S. as a lawful permanent resident, they would either have a visa in their passport or an I-94 as temporary evidence of their lawful permanent residence. Refugees, asylees and parolees are given an I-94 initially and an I-551 after they have been granted lawful permanent residence. All these documents will indicate they are authorized to work. Whether it is an I-551, I-94 or I-688B, it bears the cardholder’s alien registration number. All eligible alien status must be verified through SAVE or through the Immigration and Naturalization Services (INS) via a G845S form.

When a caretaker applies for a child, the caretaker must declare the citizen/alien status for themselves and the children they are applying for. They sign, under penalty of perjury, that the information they give is true. If the caretakers are parents of the children, each parent must sign for him/herself.

For more information on INS status codes, see the CAF Family Services Manual, Worker Guide Noncitizens-2: Citizen Alien Status.

A lawful permanent resident who would meet the noncitizen status requirement except for a determination by SSA he or she has fewer than 40 quarters of coverage may be provisionally certified for SNAP benefits while SSA investigates the number of quarters creditable to the client. A client certified under this section who is not eligible for SNAP benefits received while provisionally certified.

The provisional certification starts according to the rule on effective dates for opening benefits (461-180-0080). The provisional certification cannot run more than six months from the date of the original determination by SSA that the client does not have sufficient quarters.

Statement of Status: 461-120-0130
Amnesty Aliens: 461-120-0160

3. Social Security Number

To be eligible for medical benefits, all applicants (except assumed eligible newborns and CAWEM applicants) must provide a SSN or verify they have applied for one as a condition of eligibility.

Applicants who do not have to meet the SSN requirement include:

• A newborn is assumed eligible for medical benefits for up to one year.
• CAWEM applicants.

Nonapplicants do not have to meet the SSN requirement. It is only on a voluntary basis that a nonapplicant provide their SSN. Nonapplicants are persons who choose not to apply for benefits or who are not eligible to receive benefits, even though they may be required to provide verification of income and resources.

If an applicant has not been issued a SSN, assist the applicant in applying for a SSN. If an applicant does not recall their SSN, assist the client in verifying the number.

Do not deny or delay medical benefits to an otherwise eligible applicant pending the issuance or verification of an individual’s SSN. However, if an applicant required to meet the SSN requirement refuses to apply for or provide an SSN, the applicant is not eligible for benefits.

SSN Requirement: 461-120-0210
Newborn Requirement: 461-120-0230

4. Pursuing Assets

To be eligible for medical assistance, people must actively pursue assets for which they have a legal right or claim, i.e., unemployment compensation, workers compensation, Social Security Benefits, or any third party which may be liable for payments. However, people applying for one of the Department’s programs are not required to apply for other programs administered by the Department (e.g., QMB clients are not required to apply for SNAP).

• Also, individuals are not required to:
  • Pursue loans.
  • Pursue SSI.
  • Make an effort to obtain any asset if the individual can show good cause for not doing so. Good cause means a circumstance beyond the ability of the individual to control.

• Note: Clients are required to apply for early retirement benefits from the SSA.

To pursue assets, they must apply for and satisfy all requirements to receive benefits from other programs. They must also pursue legal remedies to obtain assets from any other source if they can secure legal counsel on a contingency fee basis. People do not have to pursue loans.

People without good cause who do not pursue assets they may be entitled to are not eligible for medical assistance. This ineligibility ends when they provide evidence that they are willing to cooperate. Only the individual who can pursue the asset is assessed the penalty and loses medical eligibility. Other individuals in the benefit group, such as other adults or children, continue to receive medical assistance.

461-120-0330

5. Pursuing Assets; Health Care Coverage and Cash Medical Support

To be eligible for medical assistance, adult members of the benefit group must pursue available health care coverage and cash medical support for members of the benefit group.

Cooperation in pursuing medical coverage includes, but is not limited to, applying for, accepting and maintaining all available cost-effective medical coverage and identifying and providing information to the Department in obtaining benefits.

Pregnant women are excused from cooperating in obtaining medical coverage. Other persons can be excused for good cause from pursuing medical coverage.

Persons (except pregnant women and persons excused for good cause) eligible for medical assistance are required to:

• Assist the Department and the Division of Child Support of the Department of Justice in establishing paternity for a child and obtaining an order directing the noncustodial parent provide health care coverage or cash medical support.
• Make a good faith effort to obtain coverage under Medicare.
• Pursue a claim for damages from personal injuries.

• Note: Medical-only clients may not be disqualified for failure to pursue a cash child support order. They are required to cooperate with paternity and medical support only.

Persons (except for pregnant women, OHP-CHP eligible individuals, OHP-OPU eligible individuals and persons excused for good cause) eligible for medical assistance are required to apply for, accept and maintain cost-effective employer-sponsored health insurance.

Insurance is considered cost-effective when the employee’s share of the premium is equal to or less than the Cost-Effective Health Insurance Premiums (HIP) standard. If the insurance is not cost-effective, the person cannot be required to apply for or accept the insurance.

In the OHP-OPU program the following applies:

• A person ( except for American Indians/Alaska Natives, persons eligible for Indian Health benefits, and persons eligible for CAWEM) who can obtain health insurance through his or her employer must cooperate in determining eligibility for the FHIAP. Rules for FHIAP are at 442-004-0000 and following. If eligible for FHIAP, the person must:
  • Cooperate in determining eligibility for FHIAP. Under FHIAP, a person receives a monthly subsidy to cover a portion of the person's health insurance premium.
  • If eligible for FHIAP, the person must apply for and accept health insurance and enroll all OHP-OPU recipients on the case who are eligible for the insurance.

Eligibility under the OHP-OPU program ends and the person receives assistance for the health insurance premiums under FHIAP. If not eligible for FHIAP, the person is not required to enroll in their employer’s insurance and, if otherwise eligible, continues to receive benefits under the OHP-OPU program.

For OHP-OPU applicants, cooperation means providing information to the Department regarding their employer’s health insurance. For OHP-OPU recipients, cooperation includes, but is not limited to, providing information to FHIAP staff for determining FHIAP eligibility and applying for and accepting the health insurance once determined eligible for a subsidy under FHIAP. All OHP-OPU recipients must enroll in the health insurance if eligible under FHIAP.

People who do not cooperate and do not have good cause, are not eligible for medical assistance. There is no ineligibility for pregnant females who refuse to cooperate. Additionally, only the individual who can legally assign rights and obtain the insurance is assessed the penalty for failure to meet this requirement, or in other words, loses medical eligibility. The other individuals in the group, such as other adults and children, continue to receive Medicaid.

Ineligibility for medical assistance ends when the person provides evidence that they are willing to cooperate. A person can be penalized only if he or she has the legal right to obtain the health insurance.

Good cause for not cooperating includes, but is not limited to, the following:

• Cooperation would result in emotional or physical harm to the dependent child or to the person. The person’s statement alone is sufficient evidence that harm would result. Additional evidence is not necessary to grant good cause.
• Continuing efforts to obtain support would be detrimental to the dependent child because the child was conceived as a result of rape or incest. The person’s statement alone is sufficient evidence on the issues of conception and detrimental effect to the child. Additional evidence is not necessary to grant good cause.
• Legal proceedings are pending for the adoption of the child.
• The parent is being helped by a public or licensed private social agency to resolve the issue of whether to release the child for adoption.

People who claim good cause for refusing to cooperate on grounds other than those listed above, have 20 days from the date of refusal to provide the statement or evidence. If they have difficulty getting evidence, allow a reasonable time to provide the information. Consider them to have good cause if they have made a good faith effort to provide verification but are unable to do so.

Medical cooperation: 461-120-0345
Medical assignment: 461-120-0315
Requirement to pursue assets: 461-120-0330
Good cause for failure to cooperate: 461-120-0350

6. Age and School Attendance

When determining eligibility for OHP medical assistance, use the following age requirements for each OHP category:

• OHP-OPU: A person age 19 or older who qualifies under the 100% income limit.
• OHP-OPC: A person under age 19 who qualifies under the 100% income limit.
• OHP-OP6: A person under the age of six who qualifies under the 133% income limit.
• OHP-OPP: A pregnant female of any age, or their newborn children under the age of one who qualifies under the 185% income limit.
• OHP-CHP: A person under the age of 19 who qualifies under the 185% income limit.
• To be eligible for continuous eligibility in OPC, an individual must be under 20 years of age.
• To be eligible for continuous eligibility in all other OHP programs, a child must be under 19 years of age.

OHP Child: 461-001-0000
Age Requirements: 461-120-0510
Regular School Attendance: 461-120-0530

7. Assumed Eligibility

Pregnant women who are receiving benefits the day the pregnancy ends are assumed eligible for OHP (except OHP-CHP) until the last day of the calendar month in which the 60th day after the last day of the pregnancy falls.

A pregnant woman who was eligible for and receiving medical assistance under any Medicaid program and becomes ineligible while pregnant is assumed eligible for Medicaid until the last day of the calendar month in which the 60th day after the last day of the pregnancy falls.

A child born to a mother eligible for and receiving OHP (except OHP-CHP) benefits is assumed eligible for medical benefits until the end of the month the child turns one year of age.

461-135-0010

8. Retroactive Medical

People determined eligible for OHP are not eligible for retroactive medical assistance.

461-135-0875

9. Eligibility Categories; Overview

To qualify for medical assistance under OHP, a person cannot:

• Be receiving or deemed to be receiving SSI benefits;
• Be eligible for Medicare, unless the person is a pregnant woman;
• Be receiving Medicaid assistance through another program; or
• Be enrolled in a health insurance plan subsidized by the FHIAP.

OHP includes five categories of people who may qualify for medical assistance. The first category is used to determine eligibility for nonpregnant adults who are 19 years of age and older. Eligibility for pregnant women is always determined using the fourth category.

There are additional categories used to determine eligibility for children. Always determine eligibility for children beginning with the second category, OHP-OPC, before moving on to the other three categories. If the family’s income exceeds the OHP-OPC income limit (100%), determine if the children might qualify under other categories, such as OHP-OP6, OHP-OPP or OHP-CHP.

Specific requirements: 461-135-1100

10. First Category; OHP-OPU

This category includes uninsured non-pregnant adults who are in a filing group with income under the (OHP-OPU) 100% income limit.

To be eligible for OHP-OPU, a person must be 19 years of age or older and must not be pregnant. An OHP-OPU person is referred to as a health plan new/noncategorical (HPN) client.

Effective July 1, 2004, the OHP-OPU program requirements were changed to limit the number of clients allowed into the program. The change was made to meet state budget requirements. The new limitations apply to OHP-OPU clients and CAWEM clients whose eligibility is based on OHP-OPU.

There are three groups of medical applicants that may be considered for OHP-OPU:

• Clients recertifying for OHP-OPU benefits without a break in assistance (including CAWEM);
• When notified their FHIAP subsidy would end effective May 31, 2008, FHIAP recipients who notify FHIAP by that date of their choice to move to OHP Standard are not considered new applicants for initial OHP Standard benefits that are effective June 1, 2008; and
• Clients converting from child welfare medical, BCCM, EXT, GAM, MAA, MAF, CHP, OPP, OSIPM, REFM or SAC program (Plus benefits) to OHP-OPU without a break in assistance.

• Note: The date of request needs to be established during the last month of eligibility, or if within 45 days of the date the Department initiates a redetermination of eligibility.

"Without a break in assistance" means that the OHP-OPU client requesting recertification returned their OHP recertification packet before their current certification expired.

"Without a break in assistance" also means a client converting from child welfare medical, BCCM, MAA, MAF, EXT, OHP-CHP, OHP-OPP, OHP-OPU, OSIPM, REFM or SAC applied for medical benefits while still receiving their prior medical program benefits. It could also mean that their worker reevaluated the client’s medical eligibility because of a reported change or eligibility review.

Example: Tina is a single adult who is not pregnant, has no children, and is not disabled. She is currently not receiving benefits under any DHS medical program. She requests medical on July 6, 2004. She may not be considered for OHP-OPU.

Example: Curt is a single adult who is receiving OHP-OPU. His certification ends on August 31. Curt turns his recertification in timely in August. Since Curt has reapplied timely, he can be considered for OHP-OPU.

Example: Larry is receiving OHP-OPU and his children are receiving OHP-OPC. His certification ends on August 31. He turns in his recertification late on September 1. His family is not eligible for any other program. Although his children can be considered for OHP, Larry cannot be considered for OHP-OPU.

In addition to other OHP eligibility requirements, an OPU client:

• Must not be covered by private major medical health insurance that is accessible to the client. Insurance is considered not accessible if one or more of the following are met:
  • Travel time or distance exceeds 30 miles or 30 minutes in urban areas or 60 miles or 60 minutes in rural areas.
  • Accessing the insurance would place a filing group member at risk of harm
• Must not have been covered by private major medical health insurance during the six months preceding the effective date for starting medical benefits. The six-month waiting period is waived if:
• The person has a condition that, without treatment, would be life-threatening or would cause permanent loss of function or disability;
• The person’s private health insurance premium was reimbursed under the provisions of 461-135-0990;
• The person’s private health insurance premium was subsidized through FHIAP or the Office of Private Health Partnerships (OPHP); or
• A member of the person’s filing group was a victim of domestic violence.
• Must meet the following eligibility requirements:
• OHP resource limit.
• OHP budgeting requirements.
• Payment of premiums unless exempt.
• The requirements in OAR 461-120-0345 related to obtaining medical coverage for members of the benefit group through the FHIAP, if applicable.

   

Specific requirements 461-135-1100
OHP-OPU; Effective Dates for the Program 461-135-1102

11. Premiums

When an OHP-OPU benefit group includes one or more nonexempt persons, a monthly premium is billed to the household. All clients eligible for OHP-OPU, if not exempt, are responsible for payment of premiums. Clients are exempt from paying a premium if they meet one of the following:

• Have OHP countable income at 10 percent or less of the Federal Poverty Level. Clients may become exempt due to income when their OHP is recertified. They may also become exempt within a certification, but only when the benefit group’s OHP income is reduced to 10 percent or less of the FPL when an OHP-OPU client leaves the benefit group or when two OHP certified households are combined during a certification.
• American Indians and Alaska Natives – American Indian/Alaska Native tribal membership or eligibility for benefits through an Indian Health Program (HNA Case Descriptor).
• Are CAWEM eligible only(CWM Case Descriptor).

The amount of the premium is determined in accordance with 461-155-0235.

Once the amount of the premium is established, the amount does not change during the certification period unless one of the following occurs:

• An OPU client becomes pregnant.
• A client becomes eligible for OPU following her assumed eligibility period as a pregnant female.
• An OPU client becomes eligible for another medical assistance program.
• An OPU client leaves the benefit group.
• OHP program cases are combined during their certification periods.

A premium is considered paid on time when the payment is received by the OHP Billing Office on or before the due date which is the 20th day of the month for which the premium was billed. The day the payment arrives in the OHP Billing Office’s post office box when sent via email or the day it is submitted via telephone or electronically to the billing office is the date it is received. A premium is past due when it has not been paid within 6 months of the due date.

Once determined eligible, OPU clients cannot be found ineligible for benefits during a certification period for premiums in arrears and past due premiums. Past due premiums and those in arrears only affect eligibility at certification and recertification.

A nonexempt OPU client can be found ineligible for not paying premiums as follows:

• An OPU applicant who does not resolve unpaid premiums during the application processing time frame is denied. The applicant must either have the premiums paid or waived to become eligible for benefits.
• An OPU applicant joining an OHP filing group is denied if the applicant has a premium arrearage or the filing group includes a person with a premium arrearage and the unpaid premiums are not resolved during the application processing time frame.

Unpaid Premiums. When applying or reapplying under the OPU program, a nonexempt applicant must pay all billed premiums to be eligible. Premiums must be paid before the applicant can be recertified. Include the requirement to pay premiums on the pend notice. If the unpaid premiums are not resolved within the 45 days from the date of request, deny medical assistance for that applicant.

Past arrearage can be canceled if the arrearage was incurred while the person was exempt from the requirement to pay a premium. As of June 1, 2006, clients with OHP countable income of 10 percent or less of the FPL when the premium is calculated, American Indians and Alaska Natives, and clients eligible under the CAWEM program are exempt.

The Department cancels any premium arrearage over three years old.

The computer determines the amount of the monthly premium by determining the number of persons in the need group, their average monthly income, and the number of nonexempts in the benefit group.

Premiums are collected by the Oregon Health Plan Premium Billing Office. OHP premium bills will state where and how to send in payments.

By mail:

OHP Premium Billing Office
PO Box 1120
Baker City, OR 97814

Payments should be made by check, money order, or cashier’s check. People who come to a branch office wanting to pay their premiums should be told to send payments to the above address. Their premium notice includes a return envelope. For questions about the billing (whether a payment was received, etc.), call the OHP Billing Office at one of the numbers listed on the billing notice toll-free 800‑647-2029, or TTY 800-264-6958.

• Note: Use the PADJ screen (type PHST, case number) to adjust premiums.

Premium requirement 461-135-1120
Specific requirements: 461-135-1100
Premium amount: 461-155-0235

12. Second Category; Oregon Health Plan for Children (OHP-OPC)

These are persons under the age of 19 in an filing group with income under 100% of the income limit. If income is at or above 100%, the person may qualify at either the OHP-OP6 (133%) or OHP-CHP (185%) level. However, assumed eligible newborn children under the age of one who are at or above the OHP-OP6 (133%) are to be coded OHP-OPP and not OHP-CHP.

Specific requirements: 461-135-1100

12. Third Category; Oregon Health Plan for Children Under Age 6 (OHP-OP6)

These are persons under the age of six in a filing group with income over the OHP-OPC (100%) income standard, but below the OHP-OP6 (133%) income limit.

Specific requirements: 461-135-1100

14. Fourth Category; Oregon Health Plan for Pregnant Females and Their Newborn Children under One Year of Age (OHP-OPP)

This category includes pregnant females in a filing group with income below the 185% income limit and their assumed eligible newborn children at or above the OHP-OP6 (133%) income limit.

15. Fifth Category; Oregon Health Plan for Children (OHP-CHP)

These are children who may qualify for medical assistance under the Children’s Health Insurance Program (CHIP) provision of the federal Balanced Budget Act of 1997. They are children under the age of 19 who are not eligible under the OPC, OP6 or OPP categories. Their financial group’s income must be below 301% FPL.

• Note: An infant under the age of one who is not an assumed eligible newborn and over the 133% income standard should always be coded OHP-CHP.
• Note:  A pregnant child over 100%, but under 185% should be coded as OPP before considering CHP

If a child in a hospital becomes ineligible for OHP because they no longer meet the age requirement for their category, they can continue to be eligible for OHP until the end of the month in which they are discharged from the hospital.

Remember the parents of CHIP children should never be forced to apply for, accept and maintain other health insurance coverage as this is not an eligibility requirement in the CHIP program like it is Medicaid.

Specific requirements: 461-135-1100

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Oregon Department of Human Services
500 Summer St. NE E02, Salem, OR 97301-1073
Phone: (503) 945-5811
Toll-free: (800) 282-8096 (V/TTY)