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Background and Purpose
The Eligibility and Enrollment Committee is chartered to develop recommendations on eligibility requirements and enrollment procedures for the Oregon Health Fund program. Issues the committee is to address include; public subsidies of costs, streamlined enrollment procedures, standards for disenrollment and changing enrollment, an outreach plan, and a process to allow employers to offer health insurance coverage beyond the defined set of essential health services.
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Eligibility
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All Oregon residents (with proof of Oregon mailing address) should be eligible for the Oregon Health Fund Program regardless of immigration status or health status.
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All low income residents (<300% FPL) would be eligible for state contributions regardless of:
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Low-income seniors should be provided with access to adequate supplemental coverage and have access to state premium contributions.
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Outreach
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Affordability
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For Oregon residents receiving a state contribution, structure total personal cost share for covered services so that it does not exceed 5% of gross household income.
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Structure the personal cost share to emphasize premiums over other types of cost sharing.
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Require no personal contribution toward premiums for individuals with incomes below 150% FPL and families with incomes below 200%, and
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Provide a sliding-scale for state premium contribution to 300% FPL for individuals, couples and families where a direct state contribution diminishes gradually to zero and personal contribution increases gradually as income approaches 300% FPL.
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Provide state tax relief (e.g., tax deductions, pre-tax premium payments, or tax credits) for households between 300% FPL to 400% FPL.
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