OAR 411-450-0030
Eligibility for Community Living Supports
(1)
An individual may not be denied community living supports or otherwise discriminated against on the basis of race, color, religion, sex, gender identity, sexual orientation, national origin, marital status, age, disability, source of income, duration of Oregon residence, or other protected classes under federal and Oregon Civil Rights laws.(2)
To be eligible for community living supports, an individual must meet the following:(a)
Be an Oregon resident.(b)
Be determined eligible for developmental disabilities services by the CDDP of the county of origin as described in OAR 411-320-0080 (Application and Eligibility Determination), except for those enrolled in the Medically Involved Children’s Waiver or the Medically Fragile Children’s Program as described in OAR chapter 411, division 300.(c)
Choose to use a case management entity for assistance with the design and management of developmental disabilities services.(d)
Be receiving a Medicaid Title XIX benefit package through OSIPM or the OCCS Medical Program.(A)
An adult is eligible for community living supports if the adult had been receiving community living supports as a child up to their 18th birthday and has not become ineligible due to section (2)(d)(B) of this rule.(B)
Eligibility for community living supports based on section (2)(d)(A) of this rule ends if:(i)
The individual does not apply for a disability determination and Medicaid within 10 business days of their 18th birthday;(ii)
The Social Security Administration or the Presumptive Medicaid Disability Determination Team of the Department finds the individual does not have a qualifying disability; or(iii)
The individual is determined by the state of Oregon to be ineligible for a Medicaid Title XIX benefit package through OSIPM or the OCCS Medical Program.(C)
Individuals receiving Medicaid Title XIX under OCCS medical coverage for services in a nonstandard living arrangement as defined in OAR 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).(ii)
The equity value of a home, which exceeds the limits in OAR 461-145-0220 (Home).(e)
Be determined to meet the level of care defined in OAR 411-415-0020 (Definitions and Acronyms).(f)
POST ELIGIBILITY TREATMENT OF INCOME Individuals with excess income must contribute to the cost of service pursuant to OAR 461-160-0610 (Client Liability; OSIPM (except OSIPM-EPD)) and OAR 461-160-0620 (Income Deductions and Client Liability; Long-Term Care Services or Home and Community-Based Care; OSIPM).(g)
Participate in a functional needs assessment and provide information necessary to complete the functional needs assessment and reassessment annually as required by the Department.(A)
Failure to participate in the functional needs assessment or to provide information necessary to complete the functional needs assessment or reassessment within the applicable time frame results in the denial of service eligibility. In the event service eligibility is denied, a written Notification of Planned Action must be provided as described in OAR chapter 411, division 318.(B)
The Department may allow additional time if circumstances beyond the control of the individual prevents timely participation in the functional needs assessment or timely submission of information necessary to complete the functional needs assessment or reassessment.(h)
A child receiving supports and services under the family support program as described in OAR 411-305-0235 (Supports and Services) is not eligible to receive community living supports.
Source:
Rule 411-450-0030 — Eligibility for Community Living Supports, https://secure.sos.state.or.us/oard/view.action?ruleNumber=411-450-0030.