Or. Admin. Code § 461-160-0540 - Determining Income Eligibility; OSIPM (except OSIPM-EPD) Living in the Community or Residing in a 24-Hour Mental Health Residential Care Setting and QMB

(1) This rule is used to determine income eligibility for the Qualified Medicare Beneficiaries (QMB) programs for all individuals, and for the Oregon Supplemental Income Program Medical (OSIPM) (except OSIPM-Employed Persons with Disabilities) programs for individuals who---

(a) Live in the community or a 24-hour mental health residential care setting;

(b) Do not receive Supplemental Security Income (SSI); and

(c) Do not receive Department (see OAR 461-001-0000) paid nursing facility services or home and community-based care (see OAR 461-001-0030).

(2) In the OSIPM program:

(a) Individuals residing in a 24-hour mental health residential care setting -- such as an adult foster home, residential treatment home, residential treatment facility, or a secure treatment facility -- meet the income requirements if their adjusted income (see OAR 461-001-0000) is equal to or less than the income standard specified in OAR 461-155-0250(6).

(b) Except as provided in subsection (a) of this section, individuals meet the income requirements if the adjusted income of the individual's financial group (see OAR 461-110-0530) is less than the OSIPM program adjusted income standard.

(3) In the Qualified Medicare Beneficiaries (QMB-BAS) and Qualified Medicare Beneficiaries-Disabled Worker (QMB-DW) programs, an individual meets the income requirements if the adjusted income of the individual's financial group is equal to or less than the QMB program adjusted income standard.

(4) In the Qualified Medicare Beneficiaries-Specified Low Income Medicare Beneficiary (QMB-SMB) and QMB-SMF programs, an individual meets the income requirements if the adjusted income of the individual's financial group is less than the adjusted income standard.

Notes

Or. Admin. Code § 461-160-0540

AFS 80-1989, f. 12-21-89, cert. ef. 2-1-90; AFS 20-1990, f. 8-17-90, cert. ef. 9-1-90; AFS 1-1999(Temp), f. & cert. ef. 2-1-99 thru 7-31-99; AFS 7-1999, f. 4-27-99, cert. ef. 5-1-99; AFS 10-2002, f. & cert. ef. 7-1-02; SSP 22-2004, f. & cert. ef. 10-1-04; SSP 4-2005, f. & cert. ef. 4-1-05; SSP 32-2010, f. & cert. ef. 10-1-10; SSP 17-2013(Temp), f. & cert. ef. 7-1-13 thru 12-28-13; SSP 26-2013, f. & cert. ef. 10-1-13; SSP 11-2018, amend filed 03/09/2018, effective 4/1/2018; SSP 22-2018, amend filed 06/05/2018, effective 7/1/2018; SSP 28-2018, amend filed 09/06/2018, effective 10/1/2018; SSP 55-2024, amend filed 09/30/2024, effective 10/1/2024

Statutory/Other Authority: ORS 409.050, 411.060, 411.070, 411.404, 411.706, 413.085 & 414.685

Statutes/Other Implemented: ORS 409.010, 411.060, 411.070, 411.404, 411.706, 42 CFR 435.219 & 42 CFR 435.726