OAR 461-135-0930. Medical Coverage for Refugees; REFM

(1) Benefits in the Refugee Assistance Medical (REFM) program are the same medical coverage as any Medicaid or CHIP program, except the Qualified Medicare Beneficiaries (QMB) program. (2) An individual is not required to meet the financial eligibility criteria for the REFM program if the individual meets all the non-financial eligibility criteria for the REFM program and the requirements of at least one of the following subsections: (a) The individual loses eligibility for any Medicaid or CHIP program, except the QMB program, due to income from employment. (b) The individual loses eligibility for any Medicaid or CHIP program, except the QMB program, and is currently receiving benefits in the Refugee Assistance (REF) program. (c) The individual had medical assistance established in another state based on refugee status granted by the United States Citizenship and Immigration Services, and: (A) Moved to Oregon and is still within the individual’s eligibility period as per OAR 461-135-0900(4); and (B) Was found not eligible for any Medicaid or CHIP program other than the QMB program. (3) An individual who is determined eligible for the REFM program will maintain eligibility for the REFM program for the remainder of their eligibility period, as per OAR 461-135-0900(4), even if the individual loses eligibility for the REF program due to having income equal to or over the countable (see OAR 461-001-0000) income and adjusted income (see OAR 461-001-0000) limits (see OAR 461-155-0030). (4) An individual applying for the REFM program is not required to apply for or receive benefits in the REF program. (5) Except for the QMB program, eligibility for all Medicaid and CHIP programs must be determined prior to determining eligibility for the REFM program. (6) When a newborn is born to a member of a REFM program benefit group (see OAR 461-110-0750): (a) Members of the benefit group may continue to receive REFM program benefits for the remainder of the eligibility period, as stated in OAR 461-135-0900(4), if the member is determined ineligible for all Medicaid and CHIP programs. (b) The newborn may receive REFM program benefits for the remainder of the eligibility period of the benefit group, as stated in OAR 461-135-0900(4), if the newborn is determined ineligible for all Medicaid and CHIP programs. (7) To be eligible for the REFM program, an individual may not be enrolled in Medicare.