If you’re an OHP (Oregon Health Plan) recipient, you’ve probably heard the term ‘OHP Redetermination’ thrown around. It’s an important process that determines your continued eligibility for OHP benefits. While it can be scary, you need to know what is happening and what you can do. Doing nothing is the worst thing you can do. In this article, we’ll take you through everything you need to know about OHP Redetermination, from what it is to how to prepare for it.
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What is OHP Redetermination?
OHP Redetermination is a process to determine if you’re still eligible for OHP benefits. It’s mandatory for all OHP recipients and occurs every year, normally. This redetermination has not happened for the last three years because of the COVID 19 State of Emergency. The process involves verifying that you still meet the eligibility criteria for OHP, such as your income, household size, and residency status. OHP Redetermination is necessary to ensure that OHP resources are directed towards those who are eligible, and it helps to prevent fraud and abuse.
If you’re dual eligible meaning you have both Medicare and OHP, click here.
Who Needs OHP Redetermination?
All OHP recipients need to undergo Redetermination every year to ensure that they are still eligible for OHP benefits. It’s not only for those who have recently enrolled in OHP but also for those who have been on OHP for years. OHP Redetermination is essential, as your circumstances may have changed since you last applied for OHP. For instance, you may have moved to a different state, had a change in household size, or had an increase in income. These changes can affect your eligibility for OHP benefits, and create the need for Redetermination.
How Does OHP Redetermination Work?
The OHP Redetermination process occurs annually and requires you to provide updated information about your income, household size, and other factors that may impact your eligibility for OHP. You will receive a letter from OHP several weeks before your Redetermination date asking you to provide this updated information.
To complete your OHP Redetermination, you will need to provide the following information:
- Proof of income: You will need to provide documentation of your income, such as pay stubs, tax returns, or bank statements. Make sure you have copies of these documents ready to submit.
- Proof of citizenship or immigration status: You will need to provide documentation of your citizenship or immigration status, such as a birth certificate or passport. Make sure you have a valid and current copy of these documents.
- Proof of residency: You will need to provide documentation of your current address, such as a utility bill or lease agreement. Make sure you have a recent copy of these documents.
- Any changes to your employment status
- Any changes to your health insurance coverage
Once you have provided this information, OHP will review your eligibility status and determine if any changes have occurred that would affect your coverage. If there are no changes to your eligibility status, your coverage will continue uninterrupted
How to Prepare for OHP Redetermination?
Preparing for OHP Redetermination can be overwhelming, but it doesn’t have to be. Below are some tips to help you prepare for the process:
- Keep track of important documents: You will need to provide proof of your income, residency, and household size during the Redetermination process. Make sure you have related documents, such as pay stubs, tax returns, and utility bills.
- Review your current eligibility: Take some time to review your current eligibility for OHP benefits before the Redetermination process. This can help you identify any changes that may affect your eligibility and address them before the Redetermination.
- Attend appointments: If you receive any requests for appointments, make sure you attend them promptly. Failure to do so may affect your eligibility for OHP benefits.
- Respond to requests for information: If you receive any requests for information from OHP, make sure you respond promptly. Failure to do so may delay the Redetermination process or affect your eligibility for OHP benefits.
What is the timeframe for Medicaid recipients to respond to OHA’s redetermination request?
Typically, Medicaid recipients have 30 days to provide the necessary documentation for redetermination. However, OHA has extended the response period to 90 days.
What happens if someone is found ineligible or fails to submit the required documentation?
If someone is no longer eligible due to making too much money for Medicaid or a change in their specific aid category, they will lose coverage 60 days after the redetermination determination.
For adults with incomes between 139% and 200% of the Federal Poverty Level (FPL), OHA is proposing a new “basic health plan” for coverage. Those with incomes between 200% and 400% of the FPL will be eligible for coverage through the exchange. Meanwhile, children are eligible for Medicaid coverage up to 300% of the FPL.
There are also specific FPL requirements for other groups, including pregnant individuals, those with disabilities, and those in foster care.
How will individuals be informed about redetermination and where can they receive assistance?
OHA will notify each recipient by mail that they must submit documentation for redetermination. This notice will contain detailed instructions on where and how to do so, as well as contact information for those who require assistance with the process.
What are my options if I lose my coverage due to Medicaid redetermination in 2023?
In the event that you lose your coverage as a result of OHP redetermination in 2023, you have several alternatives. You may be able to secure cost-effective coverage through an ACA Marketplace plan with subsidies, an employer-sponsored plan, or Medicare.
Enrolling in an Affordable Care Act (ACA) Marketplace plan becomes an option if you lose Medicaid coverage. You may also qualify for financial assistance to reduce the cost of the health insurance plan.
If you can access an employer’s health plan, you can enroll in the employer-sponsored plan during a special enrollment window. This applies to your employer’s plan or the plan of a parent or spouse. However, it’s important to act quickly since employer enrollment periods are usually only 60 days for those who lost Medicaid coverage.
Medicare is a health insurance program by the US government, covering those 65 years and above and younger people with permanent disabilities, including ALS and ESRD.
Frequently Asked Questions (FAQs)
1.What happens if I don’t complete OHP Redetermination?
If you don’t complete OHP Redetermination, your OHP coverage will end at the end of your eligibility period. You won’t be able to receive OHP benefits until you complete the Redetermination process.
2.What documents do I need to provide for OHP Redetermination?
You will need to provide documents that verify your income, residency, and household size. These may include pay stubs, tax returns, utility bills, and other relevant documents.
3.What happens if my circumstances change during the eligibility period?
If your circumstances change during the eligibility period, you should report the changes to OHP immediately. Failure to do so may affect your eligibility for OHP benefits and delay the Redetermination process.
4. What if I disagree with the Redetermination decision?
If you disagree with the Redetermination decision, you have the right to appeal the decision. You can do this by following the instructions in the notice of decision that you receive from OHP.
Conclusion
OHP Redetermination is the process that ensures that OHP benefits are directed towards those who are eligible. All OHP recipients need to undergo Redetermination every year to maintain their eligibility for OHP benefits. By understanding the Redetermination process and preparing for it, you can ensure that your OHP coverage continues without interruption. If you have any questions or concerns about OHP Redetermination, contact OHP customer service for assistance.
Need help? Call Health Plans in Oregon: 503-928-6918. Our assistance is at no cost to you.
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