Frequently asked questions – OHP eligibility
- Applicants can use Oregon Helps to find out if they may be eligible for various forms of assistance, including OHP.
- Clients are sent an OHP coverage letter that describes the current eligibility for all members of their household. Learn more in the OHP Client Handbook.
- Providers can use multiple systems to verify OHP eligibility. Clients should present their Oregon Health ID (formerly Medical Care ID) at each health care visit so that providers can check eligibility using the Client ID Number printed on the card.
If you have questions not answered on this page, go to the Contact Us page and send your question to the appropriate DMAP contact.
Q. What happens when a change occurs that affects eligibility for OHP benefits?
A. If a client’s situation changes, his or her eligibility for medical assistance may change. As a result, he or she may become ineligible for medical assistance or become eligible under a different benefit package (e.g., move from OHP Standard to OHP Plus coverage or vice versa).
If eligibility for a program that provides the OHP Plus or OHP with Limited Drug benefit packages ends because of a change, worker will evaluate your eligibility for all medical programs. You may have to provide additional information to your worker to determine your eligibility for another program. If you have unpaid premiums, you may need to pay those before you can qualify for OHP Standard. Your worker will let you know.
Q. What types of changes should clients report to DHS?
A. Clients should notify their worker right away if there are any changes in their household situation. Some examples of changes to report include:
- Changes in name, address or health care coverage
- When a member of the household becomes pregnant or gives birth or a pregnancy ends
- When someone becomes disabled or eligible for SSI
- When clients have access to or are currently covered by employer-sponsored insurance
Q. What happens when a client's benefit package changes because of a change in eligibility?
A. The household will get a new coverage letter. It will show the benefit package and copayment information for each person in the household.
Q. How long will OHP coverage last before clients need to reapply?
A. For OHP, clients must reapply after 12 months. An OHP application will be mailed at the end of the tenth month of coverage.
Q. How do unpaid premiums affect eligibility?
A. If DHS is evaluating a client’s eligibility for OHP Standard and there are outstanding premiums, the client must pay those premiums to remain eligible for OHP Standard benefits.