Or. Admin. Code § 461-160-0620 - Income Deductions and Patient Liability; Long-Term Care Services or Home and Community-Based Care; OSIPM
In the Oregon Supplemental Income Program Medical (OSIPM):
(1) Deductions from income
are made for an individual residing in or entering a long-term care facility or
receiving home and community-based care (see OAR
461-001-0030) as explained in
subsections (3)(a) to (3)(h) of this rule.
(2) The liability of an individual is
determined according to subsection (3)(i) of this rule, except as provided
otherwise in OAR 461-160-0610.
(3) Deductions are made in the following
order:
(a) One standard earned income
deduction of $65 is made from the earned income in the OSIPM program.
(b) The deductions under the plan for
self-support as allowed by OAR
461-145-0405.
(c) One of the following need standards:
(A) A $79.07 personal needs allowance for an
individual receiving long-term care services.
(B) A $90 personal needs allowance for an
individual receiving long-term care services who is eligible for VA benefits
based on unreimbursed medical expenses. The $90 allowance is allowed only when
the VA benefit has been reduced to $90.
(C) For an individual who receives
home and community-based care:
(i) Except as provided in subparagraph (ii)
of this paragraph, the OSIPM maintenance standard.
(ii) For an individual who receives in-home
services, the OSIPM maintenance standard plus $500.
(d) A community
spouse (see OAR
461-001-0030) monthly income
allowance is deducted from the income of the institutionalized
spouse (see OAR
461-001-0030) to the extent that
the income is made available to or for the benefit of the community
spouse, using the following calculation.
(A) Step 1--Determine the maintenance needs
allowance. $2,555.00 is added to the amount over $766.50 that is needed to pay
monthly shelter expenses for the principal residence of the couple. This sum or
$3,948.00, whichever is less, is the maintenance needs allowance. For the
purpose of this calculation, shelter expenses are the rent or home mortgage
payment (principal and interest), taxes, insurance, required maintenance
charges for a condominium or cooperative, and the full standard utility
allowance for the SNAP program (see OAR
461-160-0420). If an
all-inclusive rate covers items that are not allowable shelter expenses,
including meals or housekeeping in an assisted living facility, or the rate
includes utilities, to the extent they can be distinguished, these items must
be deducted from the all-inclusive rate to determine allowable shelter
expenses.
(B) Step 2--Compare
maintenance needs allowance with community spouse's countable income. The
countable (see OAR
461-001-0000) income of the
community spouse is subtracted from the maintenance needs
allowance determined in step 1. The difference is the income allowance unless
the allowance described in step 3 is greater.
(C) Step 3--If a spousal support order or
exceptional circumstances resulting in significant financial distress require a
greater income allowance than that calculated in step 2, the greater amount is
the allowance.
(e) A
dependent income allowance for an eligible dependent (see OAR
461-001-0030) as follows:
(A) For a case with a community
spouse, a deduction is permitted only if the monthly income of the
eligible dependent is below $2,555.00. To determine the income allowance of
each eligible dependent:
(i) The monthly
income of the eligible dependent is deducted from $2,555.00.
(ii) One-third of the amount remaining after
the subtraction in paragraph (A) of this subsection is the income allowance of
the eligible dependent.
(B) For a case with no community
spouse:
(i) The allowance is the
Temporary Assistance for Needy Families (TANF) adjusted income standard (see
OAR 461-155-0030) for the individual
and eligible dependents.
(ii) The
TANF standard is not reduced by the income of the dependent.
(f) Costs for
maintaining a home if the individual meets the criteria in OAR
461-160-0630.
(g) Medical deductions allowed by OAR
461-160-0030 and
461-160-0055 are made for costs
not covered under the state plan.
(h) After taking all the deductions allowed
by this rule, the remaining balance is the adjusted income
(see OAR 461-001-0000).
(i) The individual's liability is determined
as follows:
(A) For an individual receiving
home and community-based care (except individuals identified
in section (2) of this rule), the liability is the actual cost of the
home and community-based care or the adjusted
income of the individual, whichever is less. This amount must be paid
to the Department or the home and community-based care
facility each month as a condition of being eligible for home and
community-based care.
(B)
For an individual who resides in a nursing facility, the liability is the
actual cost of services or the adjusted income of the
individual, whichever is less. This amount must be paid to the facility each
month as a condition of being eligible for nursing facility services.
Notes
Statutory/Other Authority: ORS 409.050, 413.085, 411.060, 411.070, 411.404, 414.065, 414.685 & 411.706
Statutes/Other Implemented: ORS 409.010, 413.085, 411.060, 411.070, 411.404, 414.065, 414.685, 42 USC 1396r-5, 411.706 & 42 CFR 435.725- 435.735
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