OAR 461-155-0250
Income and Payment Standard; OSIPM
(1)
An individual who is assumed eligible per OAR 461-135-0010 (Assumed Eligibility for Medical Programs) is presumed to meet the income limits for the OSIPM program.(2)
An individual meeting the requirements of OAR 461-135-0745 (Eligibility for Individuals in Acute Care Settings; OSIPM) or OAR 461-135-0750 (Individuals Applying for or Receiving Long-Term Care or Home and Community-Based Care), who is not assumed eligible and does not meet the income standards set out in sections (3) or (5) of this rule, must have countable (see OAR 461-001-0000 (Definitions for Chapter 461)) income that is equal to or less than 300 percent of the full SSI standard for a single individual or have established a qualifying trust as specified in OAR 461-145-0540 (Trusts)(10)(c).(3)
An individual, other than one identified in sections (1), (2), (5), or (6) of this rule, must have adjusted income (see OAR 461-001-0000 (Definitions for Chapter 461)) below the standard in this section. [see attached table](4)
In the OSIPM (except OSIPM-EPD) program, an individual receiving Medicaid services in a nursing facility or an ICF-ID is allowed the following amounts for clothing and personal incidentals:(a)
For an individual who receives a VA pension based on unreimbursed medical expenses (UME), $90 is allowed.(b)
For all other individuals, $64.94 is allowed.(c)
For an individual identified in subsection (b) of this section with countable income (including any SSI) that is less than $64.94, the payment standard is equal to the difference between the individual’s countable income (including any SSI) and $64.94. For the purposes of this subsection, countable income includes income that would otherwise be countable for an individual who is assumed eligible under OAR 461-135-0010 (Assumed Eligibility for Medical Programs).(5)
In the OSIPM-EPD program, an individual must have adjusted earned income equal to or below 250 percent of the federal poverty level for a family of one.(6)
An individual who meets the requirements of OAR 461-135-0755 (Individual Residing in a 24-Hour Mental Health Residential Care Setting; OSIPM), is not assumed eligible, and does not meet the income standard set out in section (3) of this rule, must have adjusted income equal to or below 150 percent of the federal poverty level for a family of one.
Source:
Rule 461-155-0250 — Income and Payment Standard; OSIPM, https://secure.sos.state.or.us/oard/view.action?ruleNumber=461-155-0250.