CareAssist: Review of Applications
(1)The Authority must review an application to determine if it is complete.
(a)An applicant or the applicant’s case manager shall be notified by the Authority if the application is incomplete. Notifications shall identify what information is missing and the deadline for submitting the missing information.
(b)If the applicant does not provide the requested information before the deadline the Authority must notify the applicant in writing that the application is incomplete, shall no longer be reviewed, and that the applicant may reapply at any time.
(2)Once an application is deemed complete the Authority must verify the information submitted and make a determination within 10 business days as to whether the applicant is eligible for CAREAssist benefits.
(3)Verification of Oregon residency.
(a)An applicant must provide documentation verifying Oregon residency, as outlined in the application.
(b)An applicant may be asked to appear at an Authority office or a local case management provider’s office in person if the applicant’s residency status is in question.
(c)If an applicant is a seasonal worker who must be out of state for more than three consecutive months for employment, the applicant may be considered to reside in Oregon but must receive prior authorization, in writing, from the program before leaving the state for work.
(4)Verification of HIV/AIDS status. The applicant must ensure that a form prescribed by the Authority that verifies an applicant’s HIV/AIDS status is signed and submitted to the Authority by:
(a)The applicant’s health care provider; or
(b)The applicant’s HIV case manager, if the case manager has received documentation of HIV/AIDS status directly from a health care provider.
(5)Determination of family size. The Authority shall determine an applicant’s family size by counting the individuals related by birth, marriage, adoption, or legally defined dependent relationships who either live in the same household as the applicant and for whom the applicant is financially responsible, or whom do not live in the same household as the applicant but fall within the categories listed in subsections (b), (c) or (d) of this section, including but not limited to:
(a)A legal spouse; or
(b)A child 18 years of age or younger who qualifies as a dependent for tax filing purposes; or
(c)A child age 19 to 26 who takes 12 or more credit hours in a school term, or its equivalent; or
(d)An adult for whom the applicant has legal guardianship.
(6)Determination of monthly income.
(a)An applicant must submit to the Authority income documentation for all family members and from all sources. The Authority shall use the documentation to calculate the total monthly income for a family. Income after taxes or other withholdings may only be used when:
(A)A self-employed applicant or the applicant’s family member provides a copy of the most recent year’s IRS Form 1040 (Schedule C) in which case the Authority may allow a 50 percent deduction from gross receipts or sales; or
(B)An applicant or applicant’s family member has income from rental real estate and provides a copy of the most recent year’s IRS Form 1040 (Schedule E). In this case the Authority may use the total rental real estate income, as reported on the Schedule E. If the Schedule E shows a loss, the applicant or applicant’s family member shall be considered to have no income from this source.
(b)The Authority must determine an applicant’s income by adding together all sources of family income, and dividing that number by the applicable FPL. The resultant sum is the applicant’s percentage of the FPL. For example, if total annual income for a family of two is $31,460 and 100 percent FPL for a family of two is $15,730 for the current year: $31,460 divided by $15,730 equals two or 200 percent FPL.
Rule 333-022-1040 — CareAssist: Review of Applications,