OAR 461-160-0580
Excluded Resource; Community Spouse Provision (OSIPM except OSIPM-EPD)


In the OSIPM (except OSIPM-EPD) program:

(1)

This rule applies to an institutionalized spouse (see OAR 461-001-0030 (Definitions; OSIP, OSIPM Long-Term Care or Home and Community-Based Care)) who has applied for benefits because the individual is in or will be in a continuous period of care (see OAR 461-001-0030 (Definitions; OSIP, OSIPM Long-Term Care or Home and Community-Based Care)).

(2)

Whether a legally married (see OAR 461-001-0000 (Definitions for Chapter 461)) couple lives together or not, the determination of whether the value of the couple’s resources exceeds the eligibility limit for the institutionalized spouse for the OSIPM program is made as follows:

(a)

The first step is the determination of what the couple’s combined countable (see OAR 461-001-0000 (Definitions for Chapter 461)) resources were at the beginning of the most recent continuous period of care. (The beginning of the continuous period of care is the first month of that continuous period.)

(A)

Division 461-140 and 461-145 rules applicable to OSIPM describe which of the couple’s resources are countable resources, and are applicable to determine whether a community spouse’s resources are countable, even if the rule only applies to OSIPM individuals.

(B)

The countable resources of both spouses are combined.

(C)

At this point in the computation, the couple’s combined countable resources are considered available equally to both spouses.

(b)

The second step is the calculation of one half of what the couple’s combined countable resources were at the beginning of the continuous period of care. The community spouse’s half of the couple’s combined resources is treated as a constant amount when determining eligibility.

(c)

The third step is the determination of the community spouse’s resource allowance. The community spouse’s resource allowance is the largest of the four following amounts:

(A)

The community spouse’s half of what the couple’s combined countable resources were at the beginning of the continuous period of care, but not more than $130,380.

(B)

$26,076 (the state community-spouse resource allowance).

(C)

A court-ordered community spouse resource allowance. In this paragraph and paragraph (2)(f)(C) of this rule, the term “court-ordered community spouse resource allowance” means a “court-ordered community spouse resource allowance” that, in relation to the income generated, would raise the community spouse’s income to a court-approved monthly maintenance needs allowance. In cases where the individual became an institutionalized spouse on or after February 8, 2006, this resource allowance must use all of the individual’s available income and the community spouse’s income to meet the community spouse’s monthly maintenance needs allowance before any resources are used to generate interest income to meet the allowance.

(D)

After considering the income of the community spouse (see OAR 461-001-0030 (Definitions; OSIP, OSIPM Long-Term Care or Home and Community-Based Care)) and the income available from the institutionalized spouse, an amount which, if invested, would raise the community spouse’s income to the monthly maintenance needs allowance. The amount described in this paragraph is the amount required to purchase a single premium immediate annuity to make up the shortfall; and the amount described in this paragraph is considered only if the amount described in subparagraph (i) of this paragraph is larger than the amount described in subparagraph (ii); it is the difference between the following:
(i)
The maintenance needs allowance computed in accordance with OAR 461-160-0620 (Income Deductions and Client Liability; Long-Term Care Services or Home and Community-Based Care; OSIPM).
(ii)
The difference between:

(I)

The sum of gross countable income of the community spouse and the institutionalized spouse; and

(II)

The applicable need standard under OAR 461-160-0620 (Income Deductions and Client Liability; Long-Term Care Services or Home and Community-Based Care; OSIPM)(3)(c).

(d)

The fourth step is the determination of what the couple’s current combined countable resources are when a resource assessment is requested or the institutionalized spouse applies for OSIPM. The procedure in subsection (2)(a) (first step) of this rule is used.

(e)

The fifth step is the subtraction of the community spouse’s resource allowance from the couple’s current combined countable resources. The resources remaining are considered available to the institutionalized spouse.

(f)

The sixth step is a comparison of the value of the remaining resources to the OSIPM resource standard for one person (under OAR 461-160-0015 (Resource Limits)). If the value of the remaining resources is at or below the standard, the institutionalized spouse meets this eligibility requirement. If the value of the remaining resources is above the standard, the institutionalized spouse cannot be eligible until the value of the couple’s combined countable resources is reduced to the largest of the four following amounts:

(A)

The community spouse’s half of what the couple’s combined countable resources were at the beginning of the continuous period of care (but not more than $130,380) plus the OSIPM resource standard for one person.

(B)

$26,076 (the state community-spouse resource allowance), plus the OSIPM resource standard for one person.

(C)

A “court-ordered community spouse resource allowance” plus the OSIPM resource standard for one person. (See paragraph (2)(c)(C) of this rule for a description of the “court-ordered community spouse resource allowance”.)

(D)

The OSIPM resource standard for one person plus the amount described in the remainder of this paragraph. After considering the income of the community spouse and the income available from the institutionalized spouse, add an amount which, if invested, would raise the community spouse’s income to the monthly maintenance needs allowance. This amount is the amount required to purchase a single premium immediate annuity to make up the shortfall. Add this amount only if the amount described in subparagraph (i) of this paragraph is larger than the amount described in subparagraph (ii); it is the difference between the following:
(i)
The monthly income allowance computed in accordance with OAR 461-160-0620 (Income Deductions and Client Liability; Long-Term Care Services or Home and Community-Based Care; OSIPM).
(ii)
The difference between:

(I)

The sum of gross countable income of the community spouse and the institutionalized spouse; and

(II)

The applicable need standard under OAR 461-160-0620 (Income Deductions and Client Liability; Long-Term Care Services or Home and Community-Based Care; OSIPM)(3)(c).

(3)

Once eligibility has been established, resources equal to the community spouse’s resource allowance (under subsection (2)(c) of this rule) must be transferred to the community spouse if those resources are not already in that spouse’s name. The institutionalized spouse must indicate his or her intent to transfer the resources and must complete the transfer to the community spouse within 90 days. This period may be extended for good cause. These resources are excluded during this period. After this period, resources owned by the institutionalized spouse but not transferred out of that spouse’s name will be countable and used to determine ongoing eligibility.

(4)

The provisions of paragraph (2)(c)(C) of this rule requiring income to be considered first may be waived if the Department determines that the resulting community resource allowance would create an undue hardship on the spouse (see OAR 461-001-0000 (Definitions for Chapter 461)) of the individual.

Source: Rule 461-160-0580 — Excluded Resource; Community Spouse Provision (OSIPM except OSIPM-EPD), https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=461-160-0580.

461‑160‑0010
Use of Resources in Determining Financial Eligibility
461‑160‑0015
Resource Limits
461‑160‑0030
Overview of Costs
461‑160‑0040
Dependent Care Costs
461‑160‑0055
Medical Costs That Are Deductible
461‑160‑0060
Use of Rounding in Calculating Benefit Amount
461‑160‑0070
Benefits for Less Than a Full Month
461‑160‑0090
Employment and Independence Expenses
461‑160‑0100
How Income Affects Eligibility and Benefits
461‑160‑0140
How Income and Resources are Used to Determine Eligibility and Benefit for EA
461‑160‑0160
Earned Income Deduction
461‑160‑0193
Determining Eligibility and Calculating Payment
461‑160‑0300
Use of Income to Determine Eligibility and Benefits for ERDC
461‑160‑0400
Use of Income to Determine Eligibility and Benefits
461‑160‑0410
Use of Income and Income Deductions When There Are Ineligible or Disqualified Group Members
461‑160‑0415
Medical Deduction
461‑160‑0420
Shelter Cost
461‑160‑0430
Income Deductions
461‑160‑0500
Use of Income to Determine Benefits
461‑160‑0540
Determining Income Eligibility
461‑160‑0550
Income Deductions
461‑160‑0551
Income Deductions
461‑160‑0552
Income Deductions
461‑160‑0570
Excluded Resource
461‑160‑0580
Excluded Resource
461‑160‑0590
Assessment of Resources
461‑160‑0600
Availability of Income
461‑160‑0610
Client Liability
461‑160‑0620
Income Deductions and Client Liability
461‑160‑0630
Deduction for Maintaining a Home
461‑160‑0780
Determining Adjusted Income
461‑160‑0800
Determining Participant Fee
461‑160‑0855
Excluded Resources for Payments Received Under a Qualified Partnership Policy
Last Updated

Jun. 8, 2021

Rule 461-160-0580’s source at or​.us