OAR 461-135-0875: Specific Requirements; Retroactive Eligibility

(1) Individuals are evaluated for retroactive eligibility as follows: (a) In the Oregon Supplemental Income Program Medical (OSIPM), 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. (b) In the Qualified Disabled and Working Individual (QDWI) 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. (c) In the Specified Low-Income Medicare Beneficiary (SLMB) and Qualifying Individual (QI) 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. (d) Individuals applying for medical assistance through the Refugee Assistance Medical (REFM) program are evaluated for retroactive eligibility. (2) If eligible for medical assistance retroactively, the eligibility of the individual may not start earlier than the date indicated by OAR 461-180-0140. (3) In the Qualified Medicare Beneficiary (QMB) program, there are no retroactive medical benefits.