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FAQ: Applying for OHP and FHIAP
Other FAQs for applicants: Applying • Enrollment • Benefits • Access • Premiums
Q. What are the differences between FHIAP, OHP Standard and OHP Plus?
A. FHIAP (we pronounce it "fee-op") is a program that pays part of the premium charged to people enrolled in private health insurance. The Office of Private Health Partnerships (OPHP) administers this program. The amount FHIAP pays depends on the family income and number of family members. You can learn more by visiting the FHIAP Web site or by calling FHIAP at 1-888-564-9669.
OHP Standard and OHP Plus are Medicaid benefit packages DHS administers.
OHP Plus is a full benefit package provided to children and adults who are eligible for traditional Medicaid programs or for the Children's Health Insurance Program (CHIP). The OHP Plus benefit package does not have premiums. Some adults have small copayments for some outpatient services and prescription drugs.
OHP with Limited Drug offers the same benefits as OHP Plus, except it does not cover prescription drugs that Medicare Part D pays for. This package is for people who are eligible for both Medicaid and Medicare Part D (a national prescription drug plan). The OHP with Limited Drug benefit package does not have premiums. Some adults have small copayments for some outpatient services and prescription drugs.
OHP Standard is a limited benefit package provided under a specific medical program. The program covers only a limited number of uninsured adults who are not eligible for traditional Medicaid programs. Most people who get OHP Standard pay monthly premiums. OHP Standard does not have copayments.
Some members of your household may get the OHP Plus benefit package and some members may get the OHP Standard benefit package. The coverage letter you receive with your DHS Medical Care ID tells you who gets which benefit package.
Q. What choice do I have in source of coverage?
A. You may apply for help to pay for private health insurance premiums through FHIAP. You may also apply for medical assistance (OHP Plus and Standard benefit packages) through DHS. However, you cannot get benefits from both programs at the same time.
If you are eligible for the OHP Plus benefit package and are found eligible for FHIAP, you will have to choose the program you want.
If you are eligible for the OHP Standard benefit package and are found eligible for FHIAP, you will not have a choice. Your OHP eligibility will end when the FHIAP payments begin.
Q. Does access to employer-sponsored coverage affect my eligibility for OHP and FHIAP? If so, how?
A. It depends. If you are receiving the OHP Plus benefit package and have access to employer-sponsored health coverage, you can choose to remain on OHP and not apply for FHIAP. If you apply and are found eligible for FHIAP, you will have to choose what program you want. You cannot get benefits from both programs at the same time.
If you are receiving the OHP Standard benefit package and have access to employer-sponsored health coverage, you will be required to work with FHIAP. If you are found eligible for FHIAP, your OHP Standard benefits will end when the FHIAP payments begin as your employer coverage begins.
Q. How do I apply for OHP and FHIAP?
A. To apply for OHP, you use DHS application forms. You can get them from our local DHS branches. You can also get them from our outreach sites and the OHP Application Center by calling 1-800-359-9517 or TTY 1-800-621-5260.
To apply for FHIAP, call the FHIAP program office to learn about the application process and get on a reservation list. The toll-free number is 1-888-564-9669. The Salem number is 503-373-1692. Or click here to go to the FHIAP Web site.
Q. After I apply, when will I find out if I'm accepted?
A. If you applied for medical assistance from DHS, your DHS worker will let you know within 45 calendar days of getting a completed application. If DHS has to determine if you qualify for medical assistance based on a disability, it may take longer to make a decision. To ask about the status of your application, you can contact the office where you applied. If you applied for medical assistance by mailing in your application to the Oregon Health Plan branch, you can call toll free at 1-800-943-9249.
If you applied for help from FHIAP, your FHIAP worker will let you know if you are eligible within 30 calendar days of getting a completed application. To ask about the status of your FHIAP application, you can call 1-888-564-9669.
Q. Who might be eligible for medical assistance under the OHP Standard benefit package?
A. When a person applies for medical assistance, his or her worker will evaluate that person's eligibility for the traditional Medicaid programs or the Children's Health Insurance Program, which provide the full OHP Plus benefit package. If he or she is not eligible for any of those programs, the worker may evaluate the person's eligibility for a program that provides a limited OHP benefit package. To be evaluated for OHP Standard, the program must be open to new applicants.
If the program is open to new applicants, the person may be eligible if the person is:
Q. Who might be eligible for the OHP with Limited Drug benefit package?
A.This package is for people who are eligible for both Medicaid and Medicare Part D (a national prescription drug plan).
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