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

Rule Rule 411-015-0100
Eligibility for Nursing Facility or Medicaid Home and Community-Based Services

(1)

To be eligible for nursing facility services or Medicaid home and community-based services, a person must:

(a)

Be age 18 or older.

(b)

Be eligible for the Medicaid OHP Plus benefit package.

(A)

Individuals receiving Medicaid OHP Plus under OAR 410-200 coverage for services in a nonstandard living arrangement as defined in 461-001-0000 (Definitions for Chapter 461) are subject to the requirements in the same manner as if they were requesting these services under OSIPM, including the rules regarding:

(i)

The transfer of assets as set forth in OAR 461-140-0210 (Asset Transfer; General Information and Timelines) to 461-140-0300 (Adjustments to the Disqualification for Asset Transfer); and

(ii)

The equity value of a home which exceeds the limits as set forth in OAR 461-145-0220 (Home).

(B)

When an individual is disqualified for a transfer of assets, a notice for transfer of assets is required in accordance with OAR 461-175-0310 (Notice Situation; Asset Transfer Disqualification).

(C)

When an individual is determined ineligible for the equity value of a home, a notice for being over resources is required in accordance with 461-175-0200 (Notice Situations; General Information).

(c)

Meet the functional impairment level within the service priority levels currently served by the Department as outlined in OAR 411-015-0010 (Priority of Paid Services) and the requirements in 411-015-0015 (Current Limitations).

(2)

To be eligible for services paid through the Spousal Pay Program, an individual must meet the requirements listed above in section (1) of this rule in addition to the requirements in OAR 411-030-0080 (Spousal Pay Program).

(3)

Individuals who are age 17 or younger and reside in a nursing facility, are eligible for nursing facility services only and are not eligible to receive Medicaid home and community-based services administered by the Department’s Aging and People with Disabilities.
Source

Last accessed
Jun. 8, 2021

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