Oregon Administrative Rules › Chapter 461 - DEPARTMENT OF HUMAN SERVICES, SELF-SUFFICIENCY PROGRAMS › Division 160 - DETERMINING FINANCIAL ELIGIBILITY AND CALCULATING BENEFIT LEVEL › Section 461-160-0620 - Income Deductions and Patient Liability; Long-Term Care Services or Home and Community-Based Care; OSIPM

Current through Register Vol. 63, No. 7, July 1, 2024
In the Oregon Supplemental Income Program Medical
				(OSIPM):
(1) Deductions from income
			 are made for an individual residing in or entering a long-term care facility or
			 receiving
home and community-based care
(see OAR
			 461-001-0030) as explained in
			 subsections (3)(a) to (3)(h) of this rule.
(2) The liability of an individual is
			 determined according to subsection (3)(i) of this rule, except as provided
			 otherwise in OAR 461-160-0610.
(3) Deductions are made in the following
			 order:
(a) One standard earned income
			 deduction of $65 is made from the earned income in the OSIPM program.
(b) The deductions under the plan for
			 self-support as allowed by OAR
			 461-145-0405.
(c) One of the following need standards:
(A) A $77.14 personal needs allowance for an
			 individual receiving long-term care services.
(B) A $90 personal needs allowance for an
			 individual receiving long-term care services who is eligible for VA benefits
			 based on unreimbursed medical expenses. The $90 allowance is allowed only when
			 the VA benefit has been reduced to $90.
(C) For an individual who receives
home and community-based care
:
(i) Except as provided in subparagraph (ii)
			 of this paragraph, the OSIPM maintenance standard.
(ii) For an individual who receives in-home
			 services, the OSIPM maintenance standard plus $500.
(d) A
community
			 spouse
(see OAR
			 461-001-0030) monthly income
			 allowance is deducted from the income of the
institutionalized
			 spouse
(see OAR
			 461-001-0030) to the extent that
			 the income is made available to or for the benefit of the
community
			 spouse
, using the following calculation.
(A) Step 1--Determine the maintenance needs
			 allowance. $2,555.00 is added to the amount over $766.50 that is needed to pay
			 monthly shelter expenses for the principal residence of the couple. This sum or
			 $3,853.50, whichever is less, is the maintenance needs allowance. For the
			 purpose of this calculation, shelter expenses are the rent or home mortgage
			 payment (principal and interest), taxes, insurance, required maintenance
			 charges for a condominium or cooperative, and the full standard utility
			 allowance for the SNAP program (see OAR
			 461-160-0420). If an
			 all-inclusive rate covers items that are not allowable shelter expenses,
			 including meals or housekeeping in an assisted living facility, or the rate
			 includes utilities, to the extent they can be distinguished, these items must
			 be deducted from the all-inclusive rate to determine allowable shelter
			 expenses.
(B) Step 2--Compare
			 maintenance needs allowance with community spouse's countable income. The
countable
(see OAR
			 461-001-0000) income of the
community spouse
is subtracted from the maintenance needs
			 allowance determined in step 1. The difference is the income allowance unless
			 the allowance described in step 3 is greater.
(C) Step 3--If a spousal support order or
			 exceptional circumstances resulting in significant financial distress require a
			 greater income allowance than that calculated in step 2, the greater amount is
			 the allowance.
(e) A
			 dependent income allowance for an
eligible dependent
(see OAR
			 461-001-0030) as follows:
(A) For a case with a
community
			 spouse
, a deduction is permitted only if the monthly income of the
			 eligible dependent is below $2,555.00. To determine the income allowance of
			 each eligible dependent:
(i) The monthly
			 income of the eligible dependent is deducted from $2,555.00.
(ii) One-third of the amount remaining after
			 the subtraction in paragraph (A) of this subsection is the income allowance of
			 the eligible dependent.
(B) For a case with no
community
			 spouse
:
(i) The allowance is the
			 Temporary Assistance for Needy Families (TANF) adjusted income standard (see
			 OAR 461-155-0030) for the individual
			 and eligible dependents.
(ii) The
			 TANF standard is not reduced by the income of the dependent.
(f) Costs for
			 maintaining a home if the individual meets the criteria in OAR
			 461-160-0630.
(g) Medical deductions allowed by OAR
			 461-160-0030 and
			 461-160-0055 are made for costs
			 not covered under the state plan.
(h) After taking all the deductions allowed
			 by this rule, the remaining balance is the
adjusted income
(see OAR 461-001-0000).
(i) The individual's liability is determined
			 as follows:
(A) For an individual receiving
home and community-based care
(except individuals identified
			 in section (2) of this rule), the liability is the actual cost of the
home and community-based care
or the
adjusted
			 income
of the individual, whichever is less. This amount must be paid
			 to the Department or the
home and community-based care
facility each month as a condition of being eligible for
home and
			 community-based care
.
(B)
			 For an individual who resides in a nursing facility, the liability is the
			 actual cost of services or the
adjusted income
of the
			 individual, whichever is less. This amount must be paid to the facility each
			 month as a condition of being eligible for nursing facility services.