In addition to eligibility requirements applicable to Extended Medical Assistance (EXT) in other rules in chapter 410 division 200, this rule describes specific eligibility requirements for the EXT program.

1. (1) Except for individuals receiving MAGI Parent or Caretaker Relative (PCR) due to Continuous Eligibility (OAR 410-200-0420(3), individuals who lose eligibility for MAGI PCR for  the receipt or increase of earned income are eligible for a period of twelve months of Extended Medical Assistance (EXT) if they were eligible for and receiving MAGI PCR benefit for any one of the six months preceding the receipt or increase in earned income that resulted in the loss of MAGI PCR eligibility
2. (2) Except for those receiving benefits under OAR 410-200-0420(3), individuals who lose eligibility for MAGI PCR due to the receipt or increase of spousal support are eligible for a period of four months of EXT if they were eligible for and receiving MAGI PCR benefits for any three of the six months preceding the receipt or increase in spousal support that resulted in the loss of MAGI PCR eligibility

3. (3) The dependent children of individuals described in sections (1) and (2) are eligible for EXT for the same time period as their parent or caretaker relative if:

   1. (a) They lost Medicaid eligibility due to the parent or caretaker relative’s receipt or increase of earned income or spousal support; and
   2. (b) Eligibility is redetermined and they are not eligible for any Medicaid program.

4. (4) The EXT eligibility period as described in sections (1) and (2) above is established as follows:

   1. (a) If the determination is made on or before the 15th of the month, the EXT eligibility period will begin the first of the following month.
   2. (b) If the determination is made on or after the 16th of the month, the EXT eligibility period will begin the first of the month following the next month.
5. (5) Individuals are not eligible for EXT if there is not a parent or caretaker relative and dependent child living in the home.

6. (6) Individuals described in sections (1) through (3) of this rule who lose EXT eligibility for one of the following reasons may regain EXT eligibility for the remainder of the original EXT eligibility period if:

   1. (a) EXT eligibility was lost because the individual left the household during the EXT eligibility period. The individual may regain EXT eligibility if they return to the household; or
   2. (b) EXT eligibility was lost due to a change in circumstance that resulted in eligibility for another Medicaid program, and then a subsequent change in circumstance occurred that resulted in loss of eligibility for all Medicaid Programs.

7. (7) Individuals who lose eligibility for MAGI PCR and would be eligible to receive EXT except that they are determined eligible for another Medicaid program, and their dependent children, shall receive EXT benefits for the remainder of their original EXT eligibility period if:

   1. (a) They subsequently lose eligibility for all Medicaid programs; and
   2. (b) They continue to meet the non-financial eligibility requirements of MAGI PCR.

Statutory/Other Authority

ORS 411.095, 411.402, 411.404, 413.038 & 414.025

Statutes/Other Implemented

ORS 411.095, 411.400, 411.402, 411.404, 411.406, 411.439, 411.443, 413.032, 413.038, 414.025, 414.231, 411.447 & 414.706

History

DMAP 60-2025, amend filed 08/08/2025, effective 08/15/2025
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 53-2015, f. 9-22-15, cert. ef. 9-25-15
DMAP 31-2015(Temp), f. & cert. ef 6-16-15 thru 9-28-15
DMAP 19-2015(Temp), f. & cert. ef. 4-2-15 thru 9-28-15
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