UPDATE: In 2020, most of the requirements for Medicaid are expected to remain the same.
Oregon Medicaid benefits eligibility is made available to qualifying residents who need affordable healthcare. Oregon’s Health Plan program (Medicaid) provides free or low-cost medical assistance to applicable Oregon residents. However, first they must learn how to qualify for Medicaid, given its financial restrictions as well as residency standards.
Applicants who meet Medicaid eligibility requirements will receive covered medical services such as home health care, hospital care, basic dental care and prescription drug coverage. Medicaid benefits also include regular checkups, mental health care and addiction treatment.
Who meets the requirements for Medicaid in Oregon?
The first step in how to qualify for Medicaid in OR requires that candidates first belong to a designated patient group. Medicaid eligibility utilizes these patient categories to dispense Medicaid benefits in different fashions. Learn more about the necessary requirements for Medicaid by downloading our in-depth guide.
Those eligible for Medicaid through the Oregon Health Plan include:
- Adults and relative caretakers
- Pregnant women
- The elderly aged
- The blind
- The disabled
- Women with breast cancer or cervical cancer
Applicants who do not meet Medicaid benefits eligibility may be eligible for other medical assistance programs in Oregon, including the Qualified Medicare Beneficiary or the Citizen Alien Waived Emergent Medical program.
What Are the Requirements for Medicaid in Oregon?
In Oregon, general requirements for Medicaid must be met once an applicant determines that he or she belongs to a qualifying patient group. General Medicaid eligibility requirements must be satisfied in order to receive full Medicaid benefits in the state.
What are the Medicaid application guidelines for general eligibility criteria? Medicaid requirements ask that candidates provide the following items in order to qualify for state-sponsored medical assistance:
- Proof of residency – To qualify for Medicaid in Oregon, specifically, candidates must be able to prove that they actually live within state borders. Patients cannot request Oregon Medicaid benefits and live in a different state. Residents of Oregon can prove they live in Oregon by providing the Medicaid office with a valid driver’s license, a state ID card or via bills and mail addressed to their homes.
- Proof of citizenship – To be eligible for Medicaid, both the state of Oregon and the federal government require applicants to supply proof of United States citizenship. Those who do not possess citizenship documentation must be able to provide papers stating their legal presence in the country if they expect to receive Medicaid benefits in the state of Oregon.
- Registered Social Security Number – To qualify for Medicaid, a Social Security Number acts as proof of identity with both the state government and the federal government. In addition, Medicaid benefits are dispensed through use of a Social Security Number. Oftentimes, this federal ID number is used to identify beneficiaries on a state level.
In addition to requirements for Medicaid listed above, it is important to provide these items for any others living in the home. If a candidate for Medicaid benefits plans to add beneficiaries to his or her plan, identifying information for those family members must be available as well.
Download our helpful guide for more information on the different requirements for Medicaid.
In some cases, Medicaid requirements may differ for those with medical conditions. As an elderly patient, a blind or disabled candidate or a woman with cervical or breast cancer, the state may ask for medical documentation to confirm Medicaid eligibility.
What Are the Income Requirements for Medicaid in Oregon?
In addition to meeting residency Medicaid eligibility requirements, income restrictions also apply. Generally, adults meet Medicaid income requirements if they earn up to 138 percent of the Federal Poverty Level. This annual total is $16,000 for a single applicant or $32,900 for a family of four. Pregnant women and infants meet Oregon Medicaid eligibility requirements if their household incomes are up to 185 of the Federal Poverty Level.
Children up to age 18 meet Medicaid benefits eligibility if their families earn up to 133 percent of the Federal Poverty Level. This annual total is $46,000 per year for a family of two and $82,000 for a family of five. CHIP Oregon is available to uninsured children who do not meet Medicaid income requirements but live in households with incomes of up to 300 percent of Federal Poverty Level.
Additionally, the Oregon Breast and Cervical Cancer program is available to women who live in households with incomes of up to 250 percent of the Federal Poverty Level. Qualifying women must be 40 and older or younger than 40 and be experiencing ongoing symptoms of breast or cervical cancer. Income requirements include the following:
- Households of one may not exceed $15,800 annually.
- Households of two may not exceed $21,307 annually.
- Households of three who meet requirements for Medicaid may not exceed $26,813 annually.
- Households of four may not exceed $32,319 annually.
- Households of five may not exceed $37,825 annually.
- Households of six may not exceed $43,331 annually.
- Households of seven who meet Medicaid eligibility may not exceed $48,851 annually.
- Households of eight may not exceed $54,384 annually.
- Households with more than eight people may add $5,533 per additional household member.
Medicaid benefits eligibility depends on the following income sources, which must be provided during the Medicaid application process: unemployment payments, retirement and pension totals, capital gains, investments, net rental, net farming, prizes, gambling or award totals, Taxable Tribal Income and other taxable incomes. Other income sources like child support, Supplemental Security Income (SSI) and veteran’s payments are excluded.