Or. Admin. Code § 461-160-0580 - Excluded Resource; Community Spouse Provision (OSIPM except OSIPM-EPD)
In the Oregon Supplemental Income Program Medical (OSIPM) (except OSIPM-Employed Persons with Disabilities):
(1) This rule applies to an
institutionalized spouse (see OAR
461-001-0030) who has applied
for benefits because the individual is in or will be in a continuous
period of care (see OAR
461-001-0030).
(2) Whether a legally
married (see OAR
461-001-0000) couple lives
together or not, the determination of whether the value of the couple's
resources exceeds the eligibility limit for the institutionalized
spouse for the OSIPM program is made as follows:
(a) The first step is the determination of
what the couple's combined countable (see OAR
461-001-0000) resources were at
the beginning of the most recent continuous period of care.
(The beginning of the continuous period of care is the first
month of that continuous period.)
(A) Division
461-140 and 461-145 rules applicable to OSIPM describe which of the couple's
resources are countable resources, and are applicable to
determine whether a community spouse's resources are
countable, even if the rule only applies to OSIPM
individuals.
(B) The
countable resources of both spouses are combined.
(C) At this point in the computation, the
couple's combined countable resources are considered available
equally to both spouses.
(b) The second step is the calculation of one
half of what the couple's combined countable resources were at
the beginning of the continuous period of care. The community
spouse's half of the couple's combined resources is treated as a constant
amount when determining eligibility.
(c) The third step is the determination of
the community spouse's resource allowance. The community spouse's resource
allowance is the largest of the four following amounts:
(A) The community spouse's half of what the
couple's combined countable resources were at the beginning of
the continuous period of care, but not more than
$157,920.
(B) $31,584 (the state
community-spouse resource allowance).
(C) A court-ordered community spouse resource
allowance. In this paragraph and paragraph (2)(f)(C) of this rule, the term
"court-ordered community spouse resource allowance" means a "court-ordered
community spouse resource allowance" that, in relation to the income generated,
would raise the community spouse's income to a court-approved monthly
maintenance needs allowance. In cases where the individual became an
institutionalized spouse on or after February 8, 2006, this
resource allowance must use all of the individual's available income and the
community spouse's income to meet the community spouse's monthly maintenance
needs allowance before any resources are used to generate interest income to
meet the allowance.
(D) After
considering the income of the community spouse (see OAR
461-001-0030) and the income
available from the institutionalized spouse, an amount which,
if invested, would raise the community spouse's income to the monthly
maintenance needs allowance. The amount described in this paragraph is the
amount required to purchase a single premium immediate annuity to make up the
shortfall; and the amount described in this paragraph is considered only if the
amount described in subparagraph (i) of this paragraph is larger than the
amount described in subparagraph (ii); it is the difference between the
following:
(i) The maintenance needs allowance
computed in accordance with OAR
461-160-0620.
(ii) The difference between:
(I) The sum of gross
countable income of the community spouse and
the institutionalized spouse; and
(II) The applicable need standard under OAR
461-160-0620(3)(c).
(d) The
fourth step is the determination of what the couple's current combined
countable resources are when a resource assessment is
requested or the institutionalized spouse applies for OSIPM.
The procedure in subsection (2)(a) (first step) of this rule is used.
(e) The fifth step is the subtraction of the
community spouse's resource allowance from the couple's current combined
countable resources. The resources remaining are considered
available to the institutionalized spouse.
(f) The sixth step is a comparison of the
value of the remaining resources to the OSIPM resource standard for one person
(under OAR 461-160-0015). If the value of
the remaining resources is at or below the standard, the
institutionalized spouse meets this eligibility requirement.
If the value of the remaining resources is above the standard, the
institutionalized spouse cannot be eligible until the value of
the couple's combined countable resources is reduced to the
largest of the four following amounts:
(A) The
community spouse's half of what the couple's combined
countable resources were at the beginning of the
continuous period of care (but not more than $157,920) plus
the OSIPM resource standard for one person.
(B) $31,584 (the state community-spouse
resource allowance), plus the OSIPM resource standard for one person.
(C) A "court-ordered community spouse
resource allowance" plus the OSIPM resource standard for one person. (See
paragraph (2)(c)(C) of this rule for a description of the "court-ordered
community spouse resource allowance".)
(D) The OSIPM resource standard for one
person plus the amount described in the remainder of this paragraph. After
considering the income of the community spouse and the income
available from the institutionalized spouse, add an amount
which, if invested, would raise the community spouse's income to the monthly
maintenance needs allowance. This amount is the amount required to purchase a
single premium immediate annuity to make up the shortfall. Add this amount only
if the amount described in subparagraph (i) of this paragraph is larger than
the amount described in subparagraph (ii); it is the difference between the
following:
(i) The monthly income allowance
computed in accordance with OAR
461-160-0620.
(ii) The difference between:
(I) The sum of gross
countable income of the community spouse and
the institutionalized spouse; and
(II) The applicable need standard under OAR
461-160-0620(3)(c).
(3) Once eligibility has been established,
resources equal to the community spouse's resource allowance (under subsection
(2)(c) of this rule) must be transferred to the community
spouse if those resources are not already in that spouse's name. The
institutionalized spouse must indicate their intent to
transfer the resources and must complete the transfer to the community
spouse within 90 days. This period may be extended for good cause.
These resources are excluded during this period. After this period, resources
owned by the institutionalized spouse but not transferred out
of that spouse's name will be countable and used to determine
ongoing eligibility.
(4) The
provisions of paragraph (2)(c)(C) of this rule requiring income to be
considered first may be waived if the Department determines that the resulting
community resource allowance would create an undue hardship on the
spouse (see OAR
461-001-0000) of the
individual.
Notes
Statutory/Other Authority: ORS 411.070, 411.083, 411.404, 411.706, ORS 411.060, ORS 409.050, 413.085 & 414.685
Statutes/Other Implemented: ORS 411.060, 411.070, 411.083, 411.404, 411.706 & ORS 409.010
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.