1. (1) When establishing eligibility for MAGI Medicaid/CHIP, each applicant or beneficiary shall have their own Eligibility Determination Group (EDG) determined individually based on the following EDG rules:

   1. (a) Tax filer EDG:

      1. (A) For individuals who intend to file a federal income tax return, who are not claimed as a tax dependent by another individual, the EDG consists of:

         1. (i) The tax filer;

         2. (ii) The tax filer’s spouse, with the following considerations:

            1. (I) If living together, the tax filer’s spouse is included in the EDG of the tax filer, irrespective of the spouse’s tax filing status; and
            2. (II) If living separately, the tax filer’s spouse is included in the EDG of tax filer if they intend to claim a tax filing status of Married Filing Jointly.
         3. (iii) All individuals whom the tax filer intends to claim as tax dependents.
      2. (B) For tax filers who expect to be claimed as a tax dependent by another individual, the EDG is determined in accordance with section (1)(b) of this rule.

   2. (b) Tax dependent EDG:

      1. (A) Except as described in subsection (B) of this part (1)(b)(B), the EDG of an individual who expects to be claimed as a tax dependent is the same as the EDG of the tax filer who intends to claim them, as outlined in section (1) of this rule.

      2. (B) For tax dependents who meet any of the following exceptions, the EDG is determined in accordance with section (3) of this rule:

         1. (i) The individual is claimed as a tax dependent by someone other than a parent or spouse;
         2. (ii) The individual is a child living with both parents but is claimed as a tax dependent by one parent; or
         3. (iii) The individual is a child living with a parent and is claimed as a tax dependent by a non-custodial parent.
         4. (c) Non-filer EDG:

      3. (A) An individual’s EDG is determined in accordance with this section if:

         1. (i) The individual does not expect to file a tax return and is not claimed as a tax dependent;
         2. (ii) The individual does not expect to file a tax return and cannot substantiate whether or not they shall be included in the tax return of another individual; or
         3. (iii) The individual expects to be claimed as a tax dependent and meets an exception described in section (1)(b) of this rule.

      4. (B) The non-filer EDG consists of the following individuals, if living in the same household:

         1. (i) The individual;
         2. (ii) The individual’s spouse;
         3. (iii) The individual’s children; and
         4. (iv) If the individual is a child, their parents and child siblings;

2. (2) When establishing eligibility for OHP Bridge - Basic Health Program, each individual shall have their own Eligibility Determination Group (EDG) determined individually based on the following EDG rules:

   1. (a) Tax filer EDG:

      1. (A) For individuals who intend to file a federal income tax return, who are not claimed as a tax dependent by another individual, the EDG consists of:

         1. (i) The tax filer;
         2. (ii) The tax filer’s spouse, if they intend to claim Married Filing Jointly; and
         3. (iii) All individuals whom the tax filer intends to claim as tax dependents.
      2. (B) For tax filers who expect to be claimed as a tax dependent by another individual, the EDG is determined in accordance with subsection (b) of this section (2)(b).

   2. (b) Tax dependent EDG:

      1. (A) The EDG of an individual who is claimed as a tax dependent by a tax-filer with whom they live consists of all individuals included in the tax-filer’s EDG.
      2. (B) The EDG of an individual who is claimed as a tax dependent by someone with whom they do not live is based on non-filer EDG criteria outlined in subsection (c) of this part.

   3. (c) Non-filer EDG:

      1. (A) An individual’s EDG is determined in accordance with this section if:

         1. (i) The individual does not expect to file a tax return and is not claimed as a tax dependent;
         2. (ii) The individual does not expect to file a tax return and cannot substantiate whether or not they shall be included in the tax return of another individual;
         3. (iii) The individual expects to be claimed as a tax dependent by someone outside of their home, as referenced in section (2)(b)(B) of this part; or
         4. (iv) The Individual expects to file their tax return using a status of Married Filing Separately.

      2. (B) The non-filer EDG consists of the following individuals, if living in the same household:

         1. (i) The individual;
         2. (ii) The individual’s spouse;
         3. (iii) The individual’s children; and
         4. (iv) If the individual is a child, their parents and child siblings;

3. (3) Individuals described in this rule are still considered EDG members if they are temporarily absent from the household with intent to return to the household when the purpose of their absence is complete. Reasons for temporary absence include but are not limited to:

   1. (a) Education;
   2. (b) Military;
   3. (c) Work or training;
   4. (d) Incarceration; or
   5. (e) Hospitalization.

Statutory/Other Authority

ORS 411.402, 411.404 & 413.042

Statutes/Other Implemented

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

History

DMAP 94-2024, amend filed 05/29/2024, effective 06/01/2024
DMAP 23-2020, amend filed 05/07/2020, effective 05/08/2020
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