Redetermination & Renewing Your Coverage

What does redetermination mean for me?

As an IHN-CCO member on Oregon Health Plan, you may have to provide information to the Oregon Health Authority (OHA) to continue your coverage.

What are the changes that have happened?

• The Federal Public Health Emergency stopped the redetermination process since March 2020.
• OHA has continued to ask Oregonians to turn in the required eligibility paperwork. OHA has not revoked anyone’s Medicaid coverage if they did not respond or did not meet the eligibility criteria.

Additional changes coming in 2023:

• Children aged 0-5 would only need to apply for Medicaid once and would stay on Medicaid until their 6th birthday.
• Everyone over age 6 would reapply every 24 months.

When will redetermination begin again in Oregon?

• The pause in redetermination is connected to the Federal Public Health Emergency declaration. Because the public health emergency is still in place, the redetermination process is still paused.
• When the Federal Public Health Emergency ends, OHA will have 60 days to start the redetermination process.

Who will need to redetermine once the process is started again?

• Every person who is currently covered by Medicaid will have to go through the redetermination process. This will need to happen at some point during the 14 months after the Federal Public Health Emergency ends.

When will each individual need to redetermine?

• OHA plans to go through the redetermination process over a 12-month period. This timeframe will be divided up by populations or aid eligibility categories.
• OHA has not released their plan regarding timelines for populations or aid categories. IHN-CCO will share that information once it is released.
• Usually, people have 30 days to respond to the request for documentation, but OHA will allow people 90 days to respond.

What happens if someone is no longer eligible or does not submit the required documentation?

• If someone is over income for Medicaid (which varies by aid category) and has been determined ineligible, they will no longer be covered by Medicaid after 60 days.
• Adults with income falling within 139-200% of the Federal Poverty Level (FPL) may be eligible for the new “basic health plan” that OHA is proposing for Oregon.
• Adult within 200-400% of the FPL will be eligible for the exchange.
• Children are eligible for Medicaid up to 300% of the FPL.
• Pregnant individuals, those living with disabilities, and those in foster care have different FPL requirements.

How will IHN-CCO members know they need to “redetermine”? Where can they go for assistance?

• OHA will notify every individual through the mail that they need to submit documentation. This notice will have detailed instructions on where and how to complete the process. The notice will also include contact information for where they can get help with the process.
• IHN-CCO cannot directly assist with redetermination but can help with navigating by providing resources with community partners.