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Staff Tools | APD MAGI Manual | B. New Applicant
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DHS home | APD
Staff Tools | APD MAGI Manual | B. New Applicant
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As a general rule, most people applying for Medicaid in APD/AAA offices should also be evaluated for MAGI programs. In the past, this meant that we were required to provide every individual applying with APD/AAA with an OHP 7210 at initial application with instructions to mail it to the address listed. If the individual failed to do so, he or she waived the right to be evaluated for all Medicaid programs.
On July 6, 2020, the ONE system was upgraded to incorporate non-MAGI medial programs. Also on that date, Branch 5503 “went live” as well as the Corvallis Virtual Eligibility Center (VEC). In addition, Transition Team members in APD and SSP offices statewide also gained access to ONE while most other DHS staff lost access to view cases in ONE. Transition team members were trained in ONE and have the capability to process benefits in certain scenarios.
On August 3, the Grants Pass APD and SSP branches went live. Now that many areas of the state have gone live with the integrated ONE system, the Due Process procedure has been modified somewhat to account for the delayed implementation. Once statewide implementation has been completed sometime in February 2021, all medical applications and benefits (with a few exceptions) will be processed in the ONE system.
Until your branch goes live, either during Wave 1 in November 2020, or Wave 2 in February 2021, you can continue to process applications for non-MAGI benefits in Oregon ACCESS using the ACCESS version of the 539A or paper copies of the 7210.
Until further notice, you may suspend the practice of sending the 7210 in addition to processing the 539A. Instead, you should screen for potential MAGI eligibility using the criteria (see Section A.3 Screening for MAGI). More information is below.EXTREMELY IMPORTANT: Because only some APD/AAA branch offices have been converted to ONE while others have not and therefore determine Medicaid eligibility using different systems, it is more important than ever to always check MMIS and CMS before opening a new APD medical case. For more information about MMIS, click HERE.
Below is a quick summary of benefit package codes and program-specific case descriptors:
Benefit Packages
Case Descriptors
IMPORTANT - if your specific scenario isn't addressed, or if you experience problems with the instructions, email APD.MedicaidPolicy@dhsoha.state.or.us or OCCS.Medical.Policy @dhsoha.state.or.us
You can advise these individuals that they should apply primarily for MAGI, since the income limit for the MAGI adult program is higher than that of OSIPM.
Provide the applicant with a 7210 and route it to the ONE Customer Service Center at Oregon.Benefits@dhsoha.state.or.us for a full eligibility determination. Reminder: Applicants for medical benefits may also apply using the ONE Applicant Portal at ONE.Oregon.gov or by calling OHA at 1-800-699-9075.
If the individual is receiving Hospital Presumptive MAGI, see section G.2 of this worker guide for instructions.
If the individual is under 65, receiving SSDI, but has no Medicare or SSI, then the individual should be evaluated for MAGI, so the application must be processed in ONE. The individual will be evaluated for OSIPM if not eligible for MAGI. The local APD/AAA office should process the application for services and send the AVS request:
If the individual is under 65, alleging a disability, but has not been evaluated or determined disabled by SSA:
The individual should be evaluated for MAGI, so the application must be processed in ONE. The individual will be evaluated for OSIPM by ONE if not eligible for MAGI. The local APD/AAA office should process the service portion of the application and send the AVS request.
If the individual is currently receiving MAGI benefits:
The local APD/AAA office should process the application for services and send the AVS requestONE will automatically determine eligibility for non-MAGI benefits, so there is no need to apply separately at an APD office. They should contact a worker or log into the Applicant Portal to report a change.
6. Procedure - Existing MAGI Client Wants to Apply for General Assistance
If a MAGI recipient comes to an APD/AAA office and wants to apply for GA, you will have to do some initial screening. Only individuals who are homeless or at imminent risk of homelessness, and who allege severe physical and/or mental health conditions that will keep them from working for 12 months or will result in death should be referred to the Collaborative Disability Determination Unit (CDDU) for GA. If the individual's first stop is an APD/AAA branch and they meet these requirements:
