1. (1) This section of the rule identifies the effective date of coverage for new applicants who are approved for HSD Medical Program benefits.

   1. (a) For all HSD Medical programs except OHP Bridge - Basic Health Program (see OAR 410-200-0438) and the Extended Medical Assistance (EXT) program (see OAR 410-200-0440), the effective date is:

      1. (A) The earliest date of eligibility within the month in which the Date of Request is established; or
      2. (B) If ineligible within the month in which the Date of Request was established, the first day within the following month in which the client is determined to be eligible.

   2. (b) For OHP Bridge - Basic Health Program:

      1. (A) When the determination of eligibility is made on or before the 15th day of a month, the effective date of coverage is on the first day of the month following the month in which the determination was made; or
      2. (B) When the determination of eligibility is made on or after the 16th day of a month, the effective date of coverage is the first day of the month following the next month.

      3. (C) In accordance with the Basic Health Plan Blueprint approved by the Centers for Medicare & Medicaid Services (CMS) in June 2025, the effective date of coverage will be adjusted to January 1, 2025, if they meet all the following requirements:

         1. (i) They were enrolled in an insurance plan through the Federally Facilitated Marketplace in December 2024;
         2. (ii) They were referred from Federally Facilitated Marketplace to the ONE System prior to January 1, 2025;
         3. (iii) They were not covered by an insurance plan through the Federally Facilitated Marketplace after January 1, 2025;
         4. (iv) They were not enrolled into OHP Bridge – Basic Health Program until February 1, 2025 or later; and
         5. (v) They request to have the effective date of coverage adjusted for the OHP Bridge - Basic Health Program no later than November 30, 2025.
         6. (c) For the EXT program, the effective date is determined according to OAR 410-200-0440.

2. (2) The effective date for retroactive medical benefits (OAR 410-200-0130) for MAGI Medicaid/CHIP and Breast and Cervical Cancer Treatment Program (BCCTP, see OAR 410-200-0400) is the earlier of:

   1. (a) The first day of the earliest of the three (3) months preceding the month in which the Date of Request was established; or
   2. (b) If ineligible pursuant to section (3)(a), the earliest date of eligibility within the three (3) months preceding the month in which the Date of Request was established.

3. (3) Renewal dates:

   1. (a) For all HSD Medical Programs except EXT eligibility shall be renewed every twelve (12) months or upon the earliest Continuous Eligibility (CE) period end-date present on the case (see OAR 410-200-0135 Assumed, Continuous, and Protected Eligibility), whichever is later.
   2. (b) For redeterminations that are initiated by a reported change, outside of the established renewal date, the renewal date is not adjusted.

4. (4) When a beneficiary reports a change in circumstances, eligibility shall be redetermined for all EDG members. When a reported change results in a:

   1. (a) Reduction or loss of eligibility, the effective date for the change is as follows:

      1. (A) If the determination is made on or before the 15th of the month, the first of the next month; or
      2. (B) If the determination is made on or after the 16th of the month, the first of the month following the next month.

   2. (b) Determination of ongoing eligibility for an HSD Medical Program at the same benefit level, the effective date of the change is:

      1. (A) For Healthier Oregon beneficiaries (see OAR 410-200-0240) who report meeting the Citizenship and Non-Citizen Status Requirements set forth in OAR 410-200-0215, the first of the month in which the change is reported; or
      2. (B) For all other reported changes, the first of the month following the date the change was reported.

   3. (c) Determination of ongoing eligibility for an HSD Medical Program that is an increase in the benefit level, the effective date of the change is:

      1. (A) For beneficiaries who report a pregnancy, the effective date of the pregnancy-related HSD Medical Program benefit is the earlier of:

         1. (i) The first of the month in which the pregnancy is reported; or
         2. (ii) The date that a prenatal service related to the pregnancy was received.
      2. (B) For beneficiaries receiving coverage under the Compact of Free Association (COFA) Dental Program (OAR 410-200-0445) or Veteran Dental Program (OAR 410-200-0450) who become eligible for OHP Plus coverage, the effective date is the first of the month in which an individual meets all eligibility criteria for an OHP Plus-level HSD Medical program under OAR 410-200-0015(47)(b)-(c), 410-200-0015(47)(f)(A)-(E) and (G) or OSIPM program under OAR 461-101-0010(18).
      3. (C) For beneficiaries receiving OHP Plus coverage who become eligible for Young Adults with Special Health Care Needs (OAR 410-200-0455), the effective date is the first of the month in which an individual meets the YSCHN health-related screening criteria as defined in Specific Requirements - Young Adults with Special Health Care Needs OAR 410-200-0455 (3)(c).

5. (5) Suspending or Closing Medical Benefits:

   1. (a) The effective date for closing HSD Medical Program benefits is determined as follows:

      1. (A) Upon the death of a beneficiary, it is the beneficiary’s date of death;
      2. (B) When a beneficiary becomes ineligible, it is the last day of the month in which a timely continuing benefit decision notice is sent;
      3. (C) When a beneficiary transitions from an HSD Medical Program to another program with OHP Plus level benefits, it is the day prior to the start date of those benefits;
      4. (D) When a program ends and this is why the beneficiary is no longer eligible, it is the date the program ends;

      5. (E) It is the last day of the month in which a basic decision notice is mailed in any of the following circumstances:

         1. (i) A beneficiary or an individual authorized to act on the beneficiary’s behalf requests benefits be closed, and the request includes a written or recorded verbal signature; or
         2. (ii) A beneficiary ceases to be an Oregon resident (OAR 410-200-0200) and the Agency is informed that they’re eligible for medical benefits in another state.
      6. (F) The last day of the month in which a timely continuing benefit decision notice is sent if ongoing eligibility cannot be determined because the beneficiary does not provide required information by the deadline provided.

   2. (b) Except for benefits obtained via Hospital Presumptive Eligibility (see OAR 410-200-0105) or a presumptive eligibility period for BCCTP (see OAR 410-200-0400), prior to closing medical benefits, the Agency shall:

      1. (A) Determine eligibility for all other HSD Medical Programs; or
      2. (B) Refer the beneficiary to the Department, if applicable, and confirm that the Department has made an eligibility decision.
   3. (c) The effective date of suspension or closure for a beneficiary of HSD Medical Program benefits who become a resident of a public institution is described in Eligibility for Residents of a Public Institution OAR 410-200-0140 (2) and (3).

6. (6) The effective date for denying HSD Medical Program benefits is the earlier of the following:

   1. (a) The date the decision is made that the applicant is not eligible and notice is sent; or
   2. (b) The end of the application processing time frame, unless the time period has been extended to allow the applicant more time to provide required verification.

Statutory/Other Authority

ORS 411.402, 411.404, 413.042 & 414.534

Statutes/Other Implemented

ORS 411.400, 411.402, 411.404, 411.406, 411.439, 411.443, 413.032, 413.038, 414.025, 414.231, 414.447, 414.534, 414.536 & 414.706

History

DMAP 2-2026, amend filed 01/26/2026, effective 01/26/2026
DMAP 76-2025, temporary amend filed 10/09/2025, effective 10/09/2025 through 04/06/2026
DMAP 63-2025, amend filed 08/28/2025, effective 09/01/2025
DMAP 94-2024, amend filed 05/29/2024, effective 06/01/2024
DMAP 31-2022, minor correction filed 02/16/2022, effective 02/16/2022
DMAP 67-2020, amend filed 12/22/2020, effective 01/01/2021
DMAP 33-2020, temporary amend filed 06/29/2020, effective 07/06/2020 through 01/01/2021
DMAP 23-2020, amend filed 05/07/2020, effective 05/08/2020
DMAP 24-2016, f. & cert. ef. 6-2-16
DMAP 78-2015(Temp), f. & cert. ef. 12-22-15 thru 6-18-16
DMAP 3-2015, f. & cert. ef. 1-30-15
DMAP 67-2014(Temp), f. 11-14-14, cert. ef. 11-15-14 thru 5-13-15
DMAP 20-2014, f. & cert. ef. 3-28-14
DMAP 4-2014(Temp), f. & cert. ef. 1-15-14 thru 3-30-14
DMAP 54-2013(Temp), f. & cert. ef. 10-1-13 thru 3-30-14