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1131 Chapter 7:Worker guides • Section 6: MSP worker guides (07/2026) Dual eligible individuals will be automatically assigned to a PDP serving in Oregon. However, this enrollment can take up to 3 months to occur and may not meet the individuals’ needs. To ensure that individuals are able to get immediate access to their prescriptions, local eligibility offices should assist all dual-eligible individuals with choice counseling and enrollment assistance within the 3 months prior to the individuals’ Medicare A/B effective date(s). Facilitated enrollment—Limited Income Newly Eligible Transition (LI Net) If individuals are not enrolled in a Part D plan, they should be able to get their prescriptions by taking the following steps at any time: • Individuals will need to verify their dual-eligibility status at the pharmacy. The pharmacist can verify Medicaid eligibility by calling the ODHS MMA Hotline at 1-877-585-0007. • The pharmacist will submit the claim to the Medicare Limited Income Newly Eligible Transition (LI NET) and dispense the individual’s prescriptions. • The LI NET Contractor will enroll the individual immediately with the temporary plan. To ensure individuals receive their medications through the LI NET, workers may send an MMA Problem Solving Referral Form to Central Office (see Problem Solving section). The Central Office MMA Hotline Team will work with the pharmacy to ensure that individuals are able to access their medications. Special enrollment period People with Medicare and Medicaid (and those who receive state help for their Part B premiums and/or cost- sharing) can change plans once every calendar quarter and once during the Annual Enrollment Period. However, the individual should be enrolled in their new plan early in the month to avoid problems with enrollment. The plan will take effect the first day of the following month. If a person loses the Low-Income Subsidy from one year to the next, the individual may change plans until March 31st of the new year. There are two Special Enrollment Periods (SEPs) available for dually eligible individuals and/or individuals eligible for Extra Help (also known as low-income subsidy or LIS): 1. The Dual/LIS SEP will allow full-benefit dually eligible individuals (OHP Plus and Medicare), partial-benefit dually eligible individuals (MSP only), and Extra Help-only eligible individuals to make the following changes:
Disenroll from a Medicare Advantage plan with prescription coverage (MAPD), and return to Original Medicare, and enroll in a standalone Prescription Drug Plan (PDP)
Change their standalone Prescription Drug Plan (PDP) to another standalone Prescription Drug Plan (PDP). 2. The Integrated Care SEP will allow full-benefit dually eligible individuals (OHP Plus and Medicare) a once- per-month election into a fully integrated Dual eligible Special Needs Plan (D-SNP). It must be used to align enrollment with an integrated Dual Special Needs Plan (D-SNP) and their CCO. SEPs Full Dual (OHP and Medicare) Partial Dual (MSP only) LIS Only Dual/LIS SEP