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38 Chapter 1: Introduction to the Oregon Programs Eligibility Notebook • Section 1: Intent and overview of programs (07/2026) each of the programs. In general, BHP follows most of the rules the Health Insurance Marketplace uses for eligibility decisions and coverage start dates and the PME follows most of the MAGI Adult Medicaid program rules. For the BHP: • Must have monthly MAGI based income that exceeds 138% of the federal poverty level (FPL) and annual household income between 133% – 200% FPL for the coverage year requested. • Incarcerated individuals are not eligible for the BHP except that coverage will be maintained while the individual is pending the disposition of charges. An individual must reapply for eligibility when they cease to be a resident of a public institution. • Individuals in the BHP that are pregnant are not entitled to protected eligibility for the pregnancy or the 12-month period following the pregnancy end date. • Must enroll in a coordinated care organization (CCO). • Eligibility will begin the first of the next month if eligibility determination is made on or before the 15th of the month. If eligibility is determined on or after the 16th of the month, then eligibility will begin the first of the following month. • There is no retroactive medical coverage. • The eligibility period is for 12 months as long as they continue to meet non-financial eligibility criteria for the program. For the PME: • Must have monthly MAGI based household income between 138% FPL – 205% FPL. • Incarcerated individuals are not eligible for the PME and benefits will be reinstated when the individual ceases to be a resident of a public institution. • Individuals in the PME that are pregnant are eligible for protected eligibility for the pregnancy and the 12-month period following the pregnancy end date. • Be exempt from mandatory enrollment into a CCO or a non-Indian Managed Care Entity based on American Indian or Alaska Native status. Individuals found eligible for the PME will have a choice to enroll into a CCO or remain on an Open Card. • Eligibility will begin on the first day of the month in which all eligibility criteria is met. • Individuals are eligible for a two-year continuous eligibility period. OHP Dental Programs As of January 01, 2023, more adults are eligible for Oregon Health Plan (OHP) dental benefits. This is possible due to two bills passed in the 2022 Oregon Legislative session (House Bill 4095 and Senate Bill 1538), which created two new programs: The Veteran Dental Program and the Compacts of Free Association (COFA) Dental Program. The dental programs fall at the bottom of the medical program hierarchy. Individuals must complete the full OHP application and be evaluated for all OHP programs before they can be evaluated for a dental-only program. This means there is no separate application for these dental-only programs and individuals cannot apply for strictly dental benefits. Failure to complete the OHP application (i.e. not responding to an RFI) will not result in the