OAR 410-200-0140: Eligibility for Residents of a Public Institution

(1) A resident of a public institution is not eligible for Health System Division (HSD) Medical Program benefits, except as follows: (a) For individuals residing in an Institution for Mental Disease (IMD), including the Oregon State Hospital, who are: (A) Under age 21; (B) Age 21 if they were admitted to the IMD before their 21st birthday; or (C) Age 65 or older. (b) Residents of a public institution may be eligible for OHP Bridge – Basic Health Program benefits if they are awaiting disposition of charges. (2) For all individuals enrolled in HSD Medical Programs except for OHP Bridge – Basic Health Program who become a resident of a public institution, benefits shall be suspended for the duration of the period in which the individual is a resident of that institution. (a) The effective date of the suspension of benefits is the day following the date on which an individual becomes a resident of a public institution. (b) Except as described in section (2)(c) of this rule, suspended benefits shall be reinstated to the same level of coverage the individual was receiving when they became a resident of a public institution effective the date on which an individual ceases to be a resident of a public institution without the need for a new application when: (A) The Agency learns the individual is no longer a resident of a public institution within the twelve (12) calendar months following the date on which the change occurred; or (B) The individual leaves the public institution to be admitted to a medical facility as an inpatient with an expected stay of at least 24 hours, provided the medical facility is not associated with the public institution where the individual is a resident. (c) Individuals who were in the YSHCN program when they became a resident of a public institution and who have turned age 26 on or prior to their release date shall not have the supplemental YSHCN benefits described in OAR 410-200-0455(2)(a) and (b) reinstated upon their release. (d) Once benefits are reinstated as described in subsection (2)(b) of this rule, a redetermination of eligibility shall be processed unless benefits are restored on a case where the existing renewal date is more than two (2) calendar months beyond the month in which the action is being taken. (3) For individuals enrolled in OHP Bridge – Basic Health Program who become a resident of a public institution, benefits shall be terminated effective the day following the day on which they became a resident of a public institution except that coverage shall be maintained while the individual’s charges are pending disposition. In order to regain eligibility for OHP Bridge-Basic Health Program following release from the public institution, the individual must reapply.