1. (1) Individuals are evaluated for retroactive eligibility as follows:

   1. (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.
   2. (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.
   3. (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.
   4. (d) Individuals applying for medical assistance through the Refugee Assistance Medical (REFM) program are evaluated for retroactive eligibility.
2. (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. (3) In the Qualified Medicare Beneficiary (QMB) program, there are no retroactive medical benefits.

Statutory/Other Authority

ORS 409.050, 411.060, 411.404, 413.085 & 414.685

Statutes/Other Implemented

411.060, 411.404, 413.085, 414.685 & ORS 409.010

History

SSP 26-2026, minor correction filed 05/05/2026, effective 05/05/2026
SSP 50-2023, amend filed 11/30/2023, effective 12/01/2023
SSP 24-2023, temporary amend filed 07/01/2023, effective 07/01/2023 through 12/27/2023
SSP 22-2022, minor correction filed 02/16/2022, effective 02/16/2022
SSP 23-2017, f. 9-11-17, cert. ef. 10-1-17
SSP 16-2014, f. & cert. ef. 7-1-14
SSP 37-2013, f. 12-31-13, cert. ef. 1-1-14
SSP 30-2013(Temp), f. & cert. ef. 10-1-13 thru 3-30-14
SSP 17-2008, f. & cert. ef. 7-1-08
SSP 6-2006, f. 3-31-06, cert. ef. 4-1-06
SSP 22-2004, f. & cert. ef. 10-1-04
AFS 5-2002, f. & cert. ef. 4-1-02
AFS 6-2001, f. 3-30-01, cert. ef. 4-1-01
AFS 5-2000, f. 2-29-00, cert. ef. 3-1-00
AFS 15-1999, f. 11-30-99, cert. ef. 12-1-99
AFS 10-1995, f. 3-30-95, cert. ef. 4-1-95
AFS 2-1994, f. & cert. ef. 2-1-94
AFS 19-1993, f. & cert. ef. 10-1-93
AFS 12-1993, f. & cert. ef. 7-1-93
AFS 8-1993(Temp), f. & cert. ef. 4-26-93
AFS 28-1992, f. & cert. ef. 10-1-92
AFS 20-1990, f. 8-17-90, cert. ef. 9-1-90
AFS 80-1989, f. 12-21-89, cert. ef. 2-1-90