Oregon Department of Human Services, Aging and People with Disabilities and Developmental Disabilities

Rule Rule 411-015-0030
Extended Waiver Eligibility (EWE)

(1) An individual determined to no longer meet the criteria in 411-015-0100 (Eligibility for Nursing Facility or Medicaid Home and Community-Based Services) and assessed as Service Priority Level (SPL) 14 - 18 through the assessment process outlined in 411-015-0008 (Assessments) may be eligible to continue receiving Medicaid-funded Long-Term Support Services (LTSS) when one of the following circumstances cause unmet needs or health and safety risks, which would result in the individual being institutionalized or hospitalized within 30 days:
(a) Lack of access to shelter and support would cause the individual to deteriorate or decompensate;
(b) Without supports, the individual would lack access to safe housing or has a documented history of eviction or threats of eviction that would lead the individual to deteriorate or decompensate; or
(c) Without supports, the individual is at significant risk of abuse or exploitation.
(2) An individual who is approved for EWE may receive the Medicaid-funded services and supports for which they are eligible and demonstrate an assessed need as defined in OAR 411-027-0020 (Payment Limitations in Home and Community-Based Services) for six calendar months from the effective date.
(3) An individual meeting the criteria for EWE must have a re-assessment as described in OAR 411-015-0008 (Assessments), completed no less frequently than every 12 calendar months, or when the individual’s needs or circumstances change.
(4) EWE may be renewed for an additional six calendar months if the individual or their representative demonstrates:
(a) The individual or representative is actively working with their assigned case manager to develop a safe plan to address the circumstances identified in section (1)(a) - (c) of this rule; and
(b) The individual or representative shows demonstrable progress towards implementing the plan developed in subsection (3)(a) of this rule.
(5) Case managers may deny initial EWE if the individual does not meet the criteria in (1) of this rule.
(6) Case managers may deny renewals of EWE if the individual does not meet the criteria in (1) of this rule, or the individual or representative does not meet the criteria in section (4) of this rule.
(7) If the case manager does not deny EWE, they must submit initial and renewal requests for approval of EWE to the Central Office no later than two weeks prior to the service plan being closed.
(8) Initial and ongoing eligibility for EWE shall be determined by APD central office on a case-by-case basis.
(a) Ongoing eligibility will be determined based upon an assessment and a review of the individual’s progress towards mitigating the identified risk. In order to remain eligible, the individual must show they have been unable to mitigate the risks identified in (1) of this rule, through development and implementation of a transition plan.
(b) In order to ensure engagement, case managers must have direct contact with an individual or their representative each month as described in OAR 411-028-0020 (Scope of Case Management Services)(1). Case managers must narrate the monthly contacts in Oregon ACCESS and the steps or actions being taken to mitigate the identified risk.
(9) An individual receiving Medicaid OHP Plus under OAR chapter 410, division 200 is not eligible for EWE.

Last accessed
Jun. 8, 2021