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35 Chapter 1: Introduction to the Oregon Programs Eligibility Notebook • Section 1: Intent and overview of programs (07/2026) eligibility determinations are generally made by the Oregon Department of Human Services (ODHS). The Affordable Care Act (ACA) of 2010, which was implemented in Oregon in 2013, allowed states to expand Medicaid to cover more low-income adults under age 65 and children. The ACA also established the methodology of basing Medicaid eligibility on Modified Adjusted Gross Income (MAGI). This methodology uses taxable income and tax filing relationships to determine financial eligibility for Medicaid, CHIP, and premium tax credits and cost sharing reductions available through the health insurance marketplace. In addition to financial eligibility, applicants must also meet non-financial eligibility criteria, including Oregon residency. They must also be qualified non- citizens. Other non-financial eligibility requirements are specific to program type, such as pregnancy or age. There are several different types of assistance available based on an individual’s financial and non-financial information. The following is a list of the HSD medical programs and includes program-specific information as needed: • MAGI Child (CMO) is for children under the age of 19 with a household income at or below 133% of the federal poverty level or 185% of the federal poverty level for an infant under the age of 1.
Assumed eligible newborns (TP45) are newborns born to an individual who is eligible and receiving a Medicaid benefit in the month the child is born. Assumed eligible newborns are eligible until the end of the month of the newborn’s first birthday, even if the data for the case changes; exceptions are death, loss of residency or the child’s representative requesting a voluntary termination of the child’s eligibility. • MAGI Children’s Health Insurance Program (CHIP) is for children less than 19 years of age who are not eligible for other programs. Their household income should be at or below 300% of the federal poverty level, and they should not be covered by minimum essential coverage. • MAGI Parent or Other Caretaker Relative (PCR) program is for individuals with a dependent child in the home and income at or less than the income standard for the applicable family size.
Pregnant individuals with a dependent child in the home who meet other financial and non-financial criteria for MAGI Parent or Other Caretaker Relative program are eligible for MAGI Pregnant Parent or Other Caretaker Relative (PCPR) program. • MAGI Pregnant Woman (PWO) is for pregnant individuals or for individuals who were eligible for and receiving medical benefits during their pregnancy and are within 12 months from the end of their pregnancy, is a U.S. citizen or meets non-citizen requirements, and have income at or below 185% of the federal poverty level.
Pregnant individuals’ eligibility is protected through the 12 calendar months following the month in which the pregnancy ends, regardless of most changes reported to their case with the following exceptions: Is no longer an Oregon resident Becomes incarcerated Dies Begins receiving SSI income Requests voluntary termination of eligibility, including a request made by an individual authorized to act on the beneficiary’s behalf. • Former Foster Care Youth Medical (FFCYM) is for individuals between the ages of 18 and 26 who were in