Page 41

41 Chapter 1: Introduction to the Oregon Programs Eligibility Notebook • Section 1: Intent and overview of programs (07/2026) start date. • HPE coverage begins as of the hospital approval date (not the beginning of the determination month) and ends the last day of the month following the application approval month OR when a determination is made on a full medical application, whichever is earlier. HPE may start on the date an individual received a covered service from the qualified hospital as long as the HPE approval is submitted to OOHS within five days of the date of service. • The HPE period ends the last day of the month following the month in which the HPE period begins or the date the state makes an eligibility determination for MAGI Medicaid/CHIP and sends a basic decision notice. Note: An HPE approval is not a full eligibility determination and does NOT entitle beneficiaries to the following: • Continuous Eligibility • Assumed eligibility for babies born to HPE individuals • Protected pregnancy or post-partum coverage • Reinstatement of coverage after a period of residing in a public institution • Hearing rights • Evaluation for the OHP Bridge Programs • Evaluation for the Young Adults with Special Health Care Needs (YSHCN) program • Evaluation for the Extended Medical Assistance (EXT) program HSD Medical Programs Outside of ONE The following HSD medical programs are managed outside ONE: • The Extended Medical Assistance (EXT) Program provides medical assistance for a time after a family loses its eligibility for the PCR program due to an increase in their spousal support or earned income. Effective 08/08/2025, until a Change Request is implemented to add EXT functionality in ONE, eligibility for EXT is coded and maintained in ONE via the EXT Override Process. Note: Because EXT requires a manual determination by staff and an override is needed to provide EXT eligibility in ONE, EXT is still considered to be a program “outside of ONE”. EXT eligibility requirements are as follows: • The parent or caretaker relative of dependent child(ren) in the home meets EXT eligibility requirements if they are a PCR recipient who:

Š Became over income for PCR due to their receipt or increase in earned income (including self- employment income) or spousal support; and

Note: Spousal support that is ordered or updated on 01/01/2009 or later is excluded for

HSD MAGI medical programs. There is no EXT eligibility due to the loss of spousal support

if the spousal support income was not countable.

Š In the six months preceding the month in which earned income/spousal support income exceeded the PCR income limit, was eligible for and receiving PCR as follows: