Determining Financial Eligibility And Calculating Benefit Level

Link to law: http://arcweb.sos.state.or.us/pages/rules/oars_400/oar_461/461_160.html
Published: 2015

The Oregon Administrative Rules contain OARs filed through November 15, 2015

 

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DEPARTMENT OF HUMAN SERVICES, SELF-SUFFICIENCY PROGRAMS









 

DIVISION 160
DETERMINING FINANCIAL ELIGIBILITY AND CALCULATING BENEFIT LEVEL

461-160-0010
Use of Resources in Determining Financial Eligibility
Countable (see OAR 461-001-0000)
resources are used to determine eligibility as follows:
(1) In the EA program, the
countable resources of a financial group (see OAR 461-110-0530) are used to reduce
benefits.
(2) In the GA, GAM, QMB,
REF, SNAP, and TANF programs, a need group (see OAR 461-110-0630) is not eligible
for benefits if the financial group has countable resources above the resource limit
(OAR 461-160-0015).
(3) In the OSIP (except OSIP-EPD)
and OSIPM (except OSIPM-EPD) programs, a need group (see OAR 461-110-0630) is not
eligible for benefits if the financial group has countable resources above the resource
limit.
(a) When a child (see OAR
461-001-0000) is applying, the parental resources are deemed available to the child.
The amount deemed available to the child is the amount the parental resources exceed
the resource limit (OAR 461-160-0015) of:
(A) A one person need group,
if one parent lives in the child's household; or
(B) A two person need group,
if two parents (or one parent and the spouse of that parent) live in the child's
household.
(b) As used in this section,
parental resources mean the countable resources of:
(A) Each parent in the child's
financial group, and
(B) Each spouse of a parent
in the child's financial group.
(c) If more than one child
is applying, the value of the deemed resources is divided evenly between the applying
children.
(d) The parental resources
are not deemed available to an ineligible child.
(e) The value of the parental
resources is subject to deeming whether or not those resources are available to
the child.
(4) In the OSIP-EPD and OSIPM-EPD
programs:
(a) A need group (see OAR
461-110-0630) is not eligible for benefits if the financial group has countable
resources above the resource limit (OAR 461-160-0015).
(b) Any money in an approved
account (see OAR 461-001-0035) is excluded during the determination of eligibility.
(c) Assets purchased from
moneys in an approved account are excluded, provided they meet the requirements
of OAR 461-145-0025.
(d) Assets purchased as employment
and independence expenses (see OAR 461-001-0035) are excluded, provided they meet
the requirements of OAR 461-145-0025.
Stat. Auth.: ORS 411.060, 411.400, 411.816
& 412.049
Stats. Implemented: ORS 411.060,
411.117, 411.400, 411.816 & 412.049
Hist.: AFS 80-1989, f. 12-21-89,
cert. ef. 2-1-90; AFS 12-1991(Temp), f. & cert. ef. 7-1-91; AFS 16-1991, f.
8-27-91, cert. ef. 9-1-91; AFS 22-1995, f. 9-20-95, cert. ef. 10-1-95; AFS 42-1996,
f. 12-31-96, cert. ef. 1-1-97; AFS 10-1998, f. 6-29-98, cert. ef. 7-1-98; AFS 17-1998,
f. & cert. ef. 10-1-98; 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 9-1999, f. & cert. ef. 7-1-99;
SSP 1-2003, f. 1-31-03, cert. ef. 2-1-03; SSP 17-2004, f. & cert. ef. 7-1-04;
SSP 15-2006, f. 12-29-06, cert. ef. 1-1-07; SSP 17-2008, f. & cert. ef. 7-1-08;
SSP 9-2013(Temp), f. & cert. ef. 4-10-13 thru 10-7-13; SSP 24-2013, f. &
cert. ef. 10-1-13
461-160-0015
Resource Limits
(1) In the EA program, all countable
(see OAR 461-001-0000) resources must be used to meet the emergent need.
(2) In the ERDC and REFM
programs, there is no resource limit.
(3) In the GA, GAM, OSIP,
and OSIPM programs, the resource limit is as follows:
(a) $2,000 for a one-person
need group (see OAR 461-110-0630) and $3,000 for a two-person need group.
(b) $1,000 for an OSIP need
group eligible under OAR 461 135 0771. The total cash resources may not exceed $500
for a one-person need group or $1,000 for a two-person need group.
(c) $5,000 is the limit for
the OSIP-EPD and OSIPM-EPD programs (see OAR 461-001-0035 and 461-145-0025 for funds
that may be excluded as approved accounts).
(4) In the REF and TANF programs,
the resource limit is:
(a) $2,500 for any of the
following:
(A) A new REF or TANF applicant
for benefits.
(B) REF and TANF need groups
which do not have at least one caretaker relative (see OAR 461-001-0000) or parent
(see OAR 461-001-0000) who is receiving TANF.
(C) REF and TANF need groups
which have at least one JOBS participant who is:
(i) Receiving TANF and not
progressing in an activity (see OAR 461-001-0025) of an open JOBS case plan (see
461-001-0025); or
(ii) Serving a current JOBS
disqualification (see OAR 461-130-0330).
(b) $10,000 for a need group
not covered under subsection (a) of this section.
(5) In the QMB program, the
resource limit is amended in January of each year based on the low income subsidy
for Medicare Part D as published by the Health Resources and Services Administration
of the U.S. Department of Health and Human Services. Effective January 1, 2015 the
resource limit is $7,280 for a one-person need group and $10,930 for a need group
containing two or more individuals.
(6) In the SNAP program,
the resource limit is:
(a) $3,250 for a financial
group (see OAR 461-110-0530) with at least one member who is elderly (see 461-001-0015)
or an individual with a disability (see 461-001-0015).
(b) $2,250 for all other
financial groups.
Stat. Auth.: ORS 409.050, 411.060, 411.070,
411.404, 411.706, 411.816, 412.049, 414.231
Stats. Implemented: ORS 409.010,
411.060, 411.070, 411.404, 411.704, 411.706, 411.816, 411.837, 412.049, 414.025,
414.231, 414.826, 414.839
Hist.: AFS 80-1989, f. 12-21-89,
cert. ef. 2-1-90; AFS 12-1990, f. 3-30-90, cert. ef. 4-1-90; AFS 13-1991, f. &
cert. ef. 7-1-91; AFS 20-1991, f. & cert. ef. 10-1-91; AFS 20-1992, f. 7-31-92,
cert. ef. 8-1-92; AFS 12-1993, f. & cert. ef. 7-1-93; AFS 2-1994, f. & cert.
ef. 2-1-94; AFS 23-1994, f. 9-29-94, cert. ef. 10-1-94; AFS 29-1994, f. 12-29-94,
cert. ef. 1-1-95; AFS 10-1995, f. 3-30-95, cert. ef. 4-1-95; AFS 13-1995, f. 6-29-95,
cert. ef. 7-1-95; AFS 22-1995, f. 9-20-95, cert. ef. 10-1-95; AFS 27-1996, f. 6-27-96,
cert. ef. 7-1-96; AFS 42-1996, f. 12-31-96, cert. ef. 1-1-97; AFS 3-1997, f. 3-31-97,
cert. ef. 4-1-97; AFS 10-1998, f. 6-29-98, cert. ef. 7-1-98; 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
16-1999, f. 12-29-99, cert. ef. 1-1-00; AFS 27-2001, f. 12-21-01, cert. ef. 1-1-02;
AFS 13-2002, f. & cert. ef. 10-1-02; SSP 1-2003, f. 1-31-03, cert. ef. 2-1-03;
SSP 17-2003, f. & cert. ef. 7-1-03; SSP 29-2003(Temp), f. 10-31-03, cert. ef.
11-1-03 thru 3-31-04; SSP 6-2004, f. & cert. ef. 4-1-04; SSP 17-2004, f. &
cert. ef. 7-1-04; SSP 22-2004, f. & cert. ef. 10-1-04; SSP 6-2006, f. 3-31-06,
cert. ef. 4-1-06; SSP 15-2006, f. 12-29-06, cert. ef. 1-1-07; SSP 29-2009(Temp),
f. & cert. ef. 10-1-09 thru 3-30-10; SSP 38-2009, f. 12-31-09, cert. ef. 1-1-1;
SSP 39-2009(Temp), f. 12-31-09, cert. ef. 1-1-10 thru 6-30-10; SSP 18-2010, f. &
cert. ef. 7-1-10; SSP 42-2010(Temp), f. 12-30-10, cert. ef. 1-1-11 thru 6-30-11;
SSP 10-2011, f. 3-31-11, cert. ef. 4-1-11; SSP 26-2011(Temp), f. 9-30-11, cert.
ef. 10-1-11 thru 3-29-12; SSP 35-2011, f. 12-27-11, cert. ef. 1-1-12; SSP 37-2012,
f. 12-28-12, cert. ef. 1-1-13; SSP 39-2012(Temp), f. 12-28-12, cert. ef. 1-1-13
thru 6-30-13; SSP 8-2013, f. & cert. ef. 4-1-13; SSP 27-2013, f. & cert.
ef. 10-1-13; SSP 30-2013(Temp), f. & cert. ef. 10-1-13 thru 3-30-14; SSP 37-2013,
f. 12-31-13, cert. ef. 1-1-14; SSP 26-2014(Temp), f.& cert. ef. 10-1-14 thru
3-30-15; SSP 4-2015, f. & cert. ef. 1-1-15
461-160-0030
Overview of Costs
(1) Costs incurred
by the filing group that the filing group has a legal responsibility to pay are
deductible from income in accordance with the rules in this division of rules.
(2) The following
costs are not deductible:
(a) A cost
paid by someone outside the filing group through a reimbursement, vendor payment,
or in kind benefit.
(b) A cost
that is paid by a person or company outside the filing group or that is written
off by a medical facility. These are referred to as third party payments.
(c) The cost
for a service provided by someone in the filing group, such as child care provided
by the father while the mother works.
(d) A cost
used as an income deduction in one budget month or averaged over several months
cannot be used again.
(e) In the
OSIPM program, a cost that the client incurred while the client was serving a disqualification
from Medicaid under OAR 461-140-0210 to 461-140-0300 for a transfer of assets for
less than fair market value.
(3) In the
OSIP and OSIPM programs, to determine the medical deduction allowed under OAR 461-160-0620,
the Department uses one of the following methods:
(a) Consider
the expenses as actually incurred each month; or
(b) Consider
projected medical expenses during a prospective period not to exceed six months.
Base the projection on actual expenses experienced in a preceding period (not to
exceed six months) and on any expenses expected to be incurred by the individual
during the prospective period. Expected expenses cannot be averaged.
Stat. Auth.: ORS
409.050, 411.060, 411.400, 411.816, 412.014 & 412.049

Stats. Implemented:
ORS 409.010, 411.060, 411.400, 411.816, 412.014 & 412.049

Hist.: AFS
80-1989, f. 12-21-89, cert. ef. 2-1-90; AFS 8-1990, f. & cert. ef. 2-16-90;
AFS 10-1995, f. 3-30-95, cert. ef. 4-1-95; AFS 3-1997, f. 3-31-97, cert. ef. 4-1-97;
AFS 6-2001, f. 3-30-01, cert. ef. 4-1-01; SSP 20-2004(Temp), f. & cert. ef.
9-7-04 thru 12-31-04; SSP 22-2004, f. & cert. ef. 10-1-04; SSP 23-2004(Temp),
f. & cert. ef. 10-1-04 thru 12-31-04; SSP 24-2004, f. 12-30-04, cert. ef. 1-1-05;
SSP 6-2006, f. 3-31-06, cert. ef. 4-1-06; SSP 14-2006, f. 9-29-06, cert. ef. 10-1-06;
SSP 8-2008, f. & cert. ef. 4-1-08; SSP 8-2013, f. & cert. ef. 4-1-13
461-160-0040
Dependent Care Costs; Deduction
and Coverage
(1) In the SNAP program, dependent care
is deductible (see OAR 461-160-0430) when all of the following are true:
(a) The dependent is a member
of the filing group and is in the care, control, and custody of an individual in
the group.
(b) The dependent care provider:
(A) Is not in the filing
group; and
(B) Is not the parent (see
OAR 461-001-0000) of the dependent.
(c) The dependent care is
necessary because the client is working, commuting, on a meal break, in training,
participating in pre-employment education, or participating in an OFSET case plan
(see OAR 461-001-0020).
(2) In the ERDC, REF, and
TANF programs, the cost of dependent child care may be paid for by the Department
(is covered) only if dependent child care is necessary for the working client to
perform his or her job duties, except in the ERDC program the cost of dependent
care is allowed for approved educational hours and child care authorized under section
(5) of this rule. For a client working under a JOBS Plus agreement, child care is
covered during the time the client is engaged in work or in job search if the employer
pays the client during that time.
(3) In the ERDC, JOBS, REF,
and TANF programs, the cost of dependent child care is not covered by the Department
when free care is available, such as during school hours for school-age children.
(4) Child care is not covered
in the ERDC, REF, and TANF programs if the nature of the work of the caretaker (see
OAR 461-001-0000) does not make it necessary for a person other than the caretaker
to provide the care. Child care is not covered during a period of time when the
caretaker:
(a) Works at home and the
nature of the work allows the caretaker to provide the care without significantly
affecting the work;
(b) Provides child care in
a residence; or
(c) Works for a provider
of child care in a residence, unless the provider is a certified family child care
home under OAR 414-350-0000 to 414-350-0400.
(5) In the ERDC program the
cost of dependent child care may continue to be paid for by the Department (is covered)
during the certification period (see OAR 461-001-0000) with no change to the authorized
child care hours subject to the following provisions:
(a) When a reduction in work
hours occurs the copay may be adjusted.
(b) When a job loss occurs:
(A) When a caretaker has
a permanent job loss from all employment the copay is waived for up to three months
for a work search period, starting the month after the job loss occurred.
(B) The waiver ends at the
end of the three month period if the caretaker becomes employed.
(C) The three month work
search period does not apply when:
(i) The adult was discharged
or fired without good cause (see OAR 461-135-0070(2)) for misconduct, felony, or
theft. "Misconduct" means willful or wantonly negligent violation of the standards
of behavior which an employer has the right to expect of an employee, including
an act or series of actions that amount to a willful or wantonly negligent disregard
of an employer's interest.
(ii) The adult voluntarily
quit in anticipation of discharge or without good cause.
(c) For medical leave:
(A) When a caretaker is on
medical leave the reason for the leave must be verified including diagnosis and
prognosis under OAR 461-125-0830. Maternity leave may be authorized for three months
(12 weeks) without medical documentation.
(B) For a decrease or increase
in income during or at the end of medical leave see OAR 461-180-0005 and OAR 461-180-0030.
(C) Medical leave and maternity
leave can be extended when new verification is received prior to the end of the
month noted on the original documentation. Medical leave cannot extend beyond the
certification period.
(d) For military transition:
(A) When a caretaker who
is a discharged U.S. military member returns from active duty in a military war
zone, the copay is waived for up to six months starting the month after the military
member returns home.
(B) The copay waiver ends
at the end of the six month period if the caretaker becomes employed. The copay
waiver ends before the end of the six month period if the caretaker returns to active
duty.
(e) Under this section child
care may be used for work, work search, approved educational hours, military transition
activities, or other activities to maintain a part-time or full-time slot at a child
care facility.
(6) In the JOBS and REF programs,
the cost of child care may be covered while the care is necessary to enable the
client to participate in a case plan (see OAR 461-190-0211).
(7) In the ERDC, JOBS, JOBS
Plus, REF, and TANF programs, the cost of dependent child care may be paid for (is
covered) by the Department, only if all the following are true:
(a) The dependent child:
(A) In the ERDC program,
is a member of the benefit group (see OAR 461-110-0750) and is in the care, control,
and custody of an individual in the group.
(B) In the JOBS, JOBS Plus,
REF, and TANF programs, lives with the filing group.
(b) The provider of child
care is not in the filing group.
(c) The provider of child
care is not the parent of a child in the filing group.
(8) Coverage of the cost
of dependent care is subject to the requirements in OAR chapter 461, including OAR
461-120-0510(3), 461-135-0400, 461-155-0150, 461-160-0193, 461-165-0180, and 461-190-0211.
Stat. Auth.: ORS 411.060, 411.070, 411.404,
411.700, 411.816, 412.049
Stats. Implemented: ORS 411.060,
411.070, 411.404, 411.700, 411.816, 412.049
Hist.: AFS 80-1989, f. 12-21-89,
cert. ef. 2-1-90; AFS 13-1991, f. & cert. ef. 7-1-91; AFS 2-1992, f. 1-30-92,
cert. ef. 2-1-92; AFS 17-1992, f. & cert. ef. 7-1-92; AFS 20-1992, f. 7-31-92,
cert. ef. 8-1-92; AFS 1-1993, f. & cert. ef. 2-1-93; AFS 12-1993, f. & cert.
ef. 7-1-93; AFS 2-1994, f. & cert. ef. 2-1-94; AFS 23-1994, f. 9-29-94, cert.
ef. 10-1-94; AFS 42-1996, f. 12-31-96, cert. ef. 1-1-97; AFS 9-1997, f. & cert.
ef. 7-1-97; AFS 24-1997, f. 12-31-97, cert. ef. 1-1-98; AFS 14-1999, f. & cert.
ef. 11-1-99; AFS 6-2001, f. 3-30-01, cert. ef. 4-1-01; AFS 5-2002, f. & cert.
ef. 4-1-02; SSP 7-2003, f. & cert. ef. 4-1-03; SSP 4-2005, f. & cert. ef.
4-1-05; SSP 14-2005, f. 9-30-05, cert. ef. 10-1-05; SSP 6-2006, f. 3-31-06, cert.
ef. 4-1-06; SSP 10-2007, f. & cert. ef. 10-1-07; SSP 14-2007, f. 12-31-07, cert.
ef. 1-1-08; SSP 23-2008, f. & cert. ef. 10-1-08; SSP 4-2009(Temp), f. 3-11-09,
cert. ef. 4-1-09 thru 9-28-09; SSP 27-2009, f. & cert. ef. 9-29-09; SSP 32-2010,
f. & cert. ef. 10-1-10; SSP 13-2013, f. & cert. ef. 7-1-13; SSP 30-2013(Temp),
f. & cert. ef. 10-1-13 thru 3-30-14; SSP 38-2013, f. 12-31-13, cert. ef. 1-1-14;
SSP 29-2015(Temp), f. & cert. ef. 10-1-15 thru 3-28-16
461-160-0055
Medical Costs That are Deductible;
GA, GAM, OSIP, OSIPM, SNAP
(1) This rule applies to SNAP filing
group (see OAR 461-110-0370) members who are elderly (see OAR 461-001-0015) or who
have a disability (see OAR 461-001-0015), and to clients in the GA, GAM, OSIP, and
OSIPM programs.
(2) Medical costs are deductible
to the extent a deduction is authorized in OAR 461-160-0415 and 461-160-0430 and
in this rule.
(3) Health and hospitalization
insurance premiums and coinsurance are deductible. In the OSIPM and SNAP programs,
health insurance premiums paid less frequently than monthly may be prorated over
the period covered by the premium.
(4) In the OSIPM and SNAP
programs:
(a) Long-term care insurance
premiums are deductible if the insurance pays for services while an individual is:
(A) Receiving home and community-based
care (see OAR 461-001-0030);
(B) Receiving nursing facility
services; or
(C) In an intermediate care
facility for the mentally retarded (ICF/MR).
(b) A policy that is set
up to pay a lump sum, similar to life insurance, is not deductible.
(5) The cost of a medical
service is deductible if it is:
(a) Provided by, prescribed
by, or used under the direction of a licensed medical practitioner; or
(b) Except in the SNAP program,
a medical necessity approved by the Department.
(6) Medical deductions are
also allowed for, among other things, the cost of:
(a) Medical and dental care,
including psychotherapy, rehabilitation services, hospitalization, and outpatient
treatment.
(b) Prescription drugs and
over-the-counter medications prescribed by a licensed practitioner, the annual fee
for a drug prescription card, medical supplies and equipment, dentures, hearing
aids, prostheses, and prescribed eyeglasses.
(c) In the SNAP program,
such items as the following:
(A) Nursing care, nursing
home care, and hospitalization, including payments for an individual who was a member
of the filing group immediately prior to entering a hospital or a nursing home certified
by the state. Deduction of these payments is also allowed for an individual who
was a member of the filing group immediately prior to death if the remaining filing
group members are legally responsible for payment of the expenses.
(B) Services of an attendant,
home health aid, housekeeper, or provider of dependent care necessary due to the
client's age or illness, including an amount equal to a one-person SNAP benefit
group (see OAR 461-110-0750) if the client furnishes the majority of an attendant's
meals.
(C) Prescribed assistance
animals (such as a Seeing Eye Dog, Hearing Dog, or Housekeeper Monkey) that have
received special training to provide a service to the client. This deduction includes
the cost of acquiring these animals, their training, food, and veterinarian bills.
(D) Reasonable costs for
transportation and lodging needed to obtain medical treatment or services.
(E) Installment plan arrangements
made before a bill becomes past due. The expense is not deducted if the client defaults
and makes a second agreement.
(7) In the SNAP program,
the following costs, even if prescribed by a medical practitioner, are not allowable
medical deductions:
(a) Costs for and related
to medical use of marijuana, including registry identification cards.
(b) Costs for items related
to special diets which can be purchased with SNAP benefits including, but not limited
to, nutritional drinks and organic foods.
Stat. Auth.: ORS 409.050, 411.060, 411.070,
411.404, 411.706, 411.816, 413.085
Stats. Implemented: ORS 409.010,
409.050, 411.060, 411.070, 411.404, 411.706, 411.816, 411.837, 414.685, 414.839
Hist.: AFS 80-1989, f. 12-21-89,
cert. ef. 2-1-90; AFS 30-1990, f. 12-31-90, cert. ef. 1-1-91; AFS 13-1991, f. &
cert. ef. 7-1-91; AFS 28-1992, f. & cert. ef. 10-1-92; AFS 19-1993, f. &
cert. ef. 10-1-93; AFS 10-1995, f. 3-30-95, cert. ef. 4-1-95; AFS 3-1997, f. 3-31-97,
cert. ef. 4-1-97; AFS 10-2002, f. & cert. ef. 7-1-02; SSP 20-2004(Temp), f.
& cert. ef. 9-7-04 thru 12-31-04; SSP 22-2004, f. & cert. ef. 10-1-04; SSP
23-2004(Temp), f. & cert. ef. 10-1-04 thru 12-31-04; SSP 24-2004, f. 12-30-04,
cert. ef. 1-1-05; SSP 7-2005, f. & cert. ef. 7-1-05; SSP 10-2006, f. 6-30-06,
cert. ef. 7-1-06; SSP 14-2006, f. 9-29-06, cert. ef. 10-1-06; SSP 15-2006, f. 12-29-06,
cert. ef. 1-1-07; SSP 14-2007, f. 12-31-07, cert. ef. 1-1-08; SSP 27-2012(Temp),
f. & cert. ef. 7-12-12 thru 1-8-13; SSP 37-2012, f. 12-28-12, cert. ef. 1-1-13;
SSP 8-2013, f. & cert. ef. 4-1-13; SSP 17-2013(Temp), f. & cert. ef. 7-1-13
thru 12-28-13; SSP 26-2013, f. & cert. ef. 10-1-13; SSP 9-2015(Temp), f. &
cert. ef. 3-10-15 thru 9-5-15; SSP 17-2015, f. & cert. ef. 6-30-15
461-160-0060
Use of Rounding in Calculating Benefit Amount
(1) In the REF and TANF programs, a
benefit amount not a whole number of dollars is rounded down to the next lower whole
dollar.
(2) In the ERDC program,
total countable income is rounded down to the next lower whole dollar. The benefit
figures are not rounded.
(3) In the GA, GAM, OSIP,
OSIPM, and QMB programs, rounding is not used.
(4) In the SNAP program:
(a) Except as provided in
subsection (b) of this section, when income and deductions are calculated, a figure
ending with less than 50 cents is rounded to the next lower dollar and a figure
ending with 50 cents or more is rounded to the next higher dollar.
(b) After multiplying the
adjusted income by 30 percent, any amount from 1 to 99 cents is rounded up to the
next higher dollar.
Stat. Auth.: ORS 411.060, 411.404, 411.816,
412.014, 412.049
Stats. Implemented: 411.060,
411.404, 411.816, 412.014, 412.049
Hist.: AFS 80-1989, f. 12-21-89,
cert. ef. 2-1-90; AFS 13-1991, f. & cert. ef. 7-1-91; AFS 2-1994, f. & cert.
ef. 2-1-94; AFS 10-1995, f. 3-30-95, cert. ef. 4-1-95; AFS 42-1996, f. 12-31-96,
cert. ef. 1-1-97; AFS 3-1997, f. 3-31-97, cert. ef. 4-1-97; AFS 10-2002, f. &
cert. ef. 7-1-02; SSP 29-2003(Temp), f. 10-31-03, cert. ef. 11-1-03 thru 3-31-04;
SSP 6-2004, f. & cert. ef. 4-1-04; SSP 5-2009, f. & cert. ef. 4-1-09; SSP
30-2013(Temp), f. & cert. ef. 10-1-13 thru 3-30-14; SSP 38-2013, f. 12-31-13,
cert. ef. 1-1-14
461-160-0070
Benefits for Less Than a Full Month
In the GA, OSIP, REF, SNAP, and TANF programs, if in a month a benefit group is eligible for less than a full month's benefits (such as the initial and closing months), benefits for that month are determined as follows:
(1) The benefit amount for a full month is determined.
(2) The full benefit amount is divided by the number of days in the payment month to determine the daily benefit.
(3) The daily benefit is multiplied by the number of days in the month the group is eligible. The result is the benefit amount for the partial month (prorated benefit), except as adjusted by section (4) of this rule.
(4) Rounding is used in the calculation of the prorated benefit as follows:
(a) In the REF, SNAP, and TANF programs, if the prorated benefit is not a whole dollar amount, the prorated benefit is rounded to the next lower whole dollar.
(b) In the GA and OSIP programs, the prorated benefit is not rounded.
Stat. Auth.: ORS 411.060

Stats. Implemented: ORS 411.060

Hist.: AFS 80-1989, f. 12-21-89, cert. ef. 2-1-90; AFS 30-1990, f. 12-31-90, cert. ef. 1-1-91; AFS 13-1991, f. & cert. ef. 7-1-91; AFS 42-1996, f. 12-31-96, cert. ef. 1-1-97; AFS 10-2002, f. & cert. ef. 7-1-02; SSP 14-2005, f. 9-30-05, cert. ef. 10-1-05
461-160-0090
Employment and Independence Expenses; OSIP-EPD and OSIPM-EPD
In the OSIP-EPD and OSIPM-EPD programs, an employment and independence expense (see OAR 461-001-0035) must be approved by the branch office prior to its use as a deduction from countable income (see OAR 461-140-0010).
Stat. Auth.: ORS 411.060, 411.070, 414.042

Stats. Implemented: ORS 411.060, 411.070, 414.042

Hist.: 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; SSP 15-2006, f. 12-29-06, cert. ef. 1-1-07
461-160-0100
How Income Affects Eligibility and
Benefits; REF, SFPSS, TANF
(1) Countable income (see OAR 461-001-0000)
and adjusted income (see OAR 461-001-0000) are used to determine eligibility for
the REF, SFPSS, and TANF programs using the countable and adjusted income standards
in OAR 461-155-0030 as explained in this section:
(a) The financial group's
countable income is compared to the countable income limit standard for the need
group. If countable income equals or exceeds the standard, the benefit group is
not eligible.
(b) If countable income is
less than the countable income standard, the adjusted income is compared to the
payment standard. If the adjusted income equals or exceeds the payment standard
for the need group (see OAR 461-110-0630), the benefit group (see OAR 461-110-0750)
is not eligible. If the adjusted income is less than the payment standard for the
need group, the benefit group meets the income eligibility standard.
(2) Adjusted income is used
to determine the monthly benefit in the REF, SFPSS, and TANF (except for a client
who receives JOBS Plus income — see OAR 461-145-0130) programs as explained
in this section:
(a) The monthly benefit is
calculated by subtracting adjusted income from the applicable payment standard for
the need group. The remainder is the benefit amount except for a need group that
includes an ineligible non-citizen.
(b) If the need group contains
an ineligible non-citizen, the benefit is the lesser of the remainder calculated
in subsection (a) of this section and the payment standard for the benefit group.
Stat. Auth.: ORS 411.060, 411.070, 411.404,
411.816, 412.006, 412.009, 412.014, 412.049
Stats. Implemented: ORS 411.060,
411.070, 411.404, 411.816, 412.006, 412.009, 412.014, 412.049
Hist.: AFS 80-1989, f. 12-21-89,
cert. ef. 2-1-90; AFS 13-1991, f. & cert. ef. 7-1-91; AFS 20-1992, f. 7-31-92,
cert. ef. 8-1-92; AFS 16-1993, f. & cert. ef. 9-1-93; AFS 23-1994, f. 9-29-94,
cert. ef. 10-1-94; AFS 13-1995, f. 6-29-95, cert. ef. 7-1-95; AFS 9-1997, f. &
cert. ef. 7-1-97; AFS 6-2001, f. 3-30-01, cert. ef. 4-1-01; SSP 26-2008, f. 12-31-08,
cert. ef. 1-1-09; SSP 30-2013(Temp), f. & cert. ef. 10-1-13 thru 3-30-14; SSP
38-2013, f. 12-31-13, cert. ef. 1-1-14
461-160-0140
How Income and Resources are Used
to Determine Eligibility and Benefit for EA
The Department considers a client’s
income and resources in determining eligibility and benefit level for EA as follows:
(1) The financial group’s countable income is compared to the TANF adjusted income payment standard
for the benefit group. If countable income equals or exceeds the standard, the benefit
group is not eligible.
(2) If countable income is
less than the standard and the financial group meets all other EA eligibility requirements,
the client is required to use all income and resources that are immediately available
to meet the emergent need. The EA benefit is calculated by subtracting all income
and resources that are immediately available to the client from the amount needed
to meet the emergent need. The remainder is the benefit, not to exceed the limit
in OAR 461-155-0070.
Stat. Auth.: ORS 411.060 & 412.049
Stats. Implemented: ORS 411.060,
411.117 & 412.049
Hist.: AFS 80-1989, f. 12-21-89,
cert. ef. 2-1-90; AFS 7-1990, f. & cert. ef. 2-1-90; AFS 12-1990, f. 3-30-90,
cert. ef. 4-1-90; AFS 18-1990(Temp), f. & cert. ef. 7-13-90; AFS 26-1990, f.
& cert. ef. 11-29-90; AFS 13-1991, f. & cert. ef. 7-1-91; AFS 8-1992, f.
& cert. ef. 4-1-92; AFS 19-1993, f. & cert. ef. 10-1-93; AFS 21-1995, f.
9-20-95, cert. ef. 10-1-95; AFS 16-1996, f. 4-29-96, cert. ef. 5-1-96; AFS 9-1999,
f. & cert. ef. 7-1-99; AFS 10-2002, f. & cert. ef. 7-1-02; SSP 17-2004,
f. & cert. ef. 7-1-04
461-160-0160
Earned Income Deduction; REF, TANF
(1) In the REF program, the earned income
deduction authorized in this division of rules is allowed for each person in the
financial group who has earned income. The earned income deduction is 50 percent
of the client's gross earned income including self-employment income.
(2) In the TANF program:
(a) For a self-employed client
participating in the microenterprise component of the JOBS program, the earned income
deduction for income earned in the microenterprise is 50 percent of the client's
countable income calculated pursuant to OAR 461-145-0920 and 461-145-0930.
(b) For all other income,
the earned income deduction is 50 percent of the client's gross earned income, including
self-employment income.
Stat. Auth.: ORS 411.060, 412.049
Stats. Implemented: ORS 411.060,
412.049
Hist.: AFS 80-1989, f. 12-21-89,
cert. ef. 2-1-90; AFS 12-1990, f. 3-30-90, cert. ef. 4-1-90; AFS 20-1990, f. 8-17-90,
cert. ef. 9-1-90; AFS 30-1990, f. 12-31-90, cert. ef. 1-1-91; AFS 13-1991, f. &
cert. ef. 7-1-91; AFS 15-1991(Temp), f. & cert. ef. 8-16-91; AFS 20-1991, f.
& cert. ef. 10-1-91; AFS 8-1992, f. & cert. ef. 4-1-92; AFS 20-1992, f.
7-31-92, cert. ef. 8-1-92; AFS 16-1993, f. & cert. ef. 9-1-93l; AFS 10-1995,
f. 3-30-95, cert. ef. 4-1-95; AFS 13-1995, f. 6-29-95, cert. ef. 7-1-95; AFS 36-1996,
f. 10-31-96, cert. ef. 11-1-96; AFS 9-1997, f. & cert. ef. 7-1-97; AFS 10-2002,
f. & cert. ef. 7-1-02; SSP 23-2003, f. & cert. ef. 10-1-03; SSP 17-2004,
f. & cert. ef. 7-1-04; SSP 30-2013(Temp), f. & cert. ef. 10-1-13 thru 3-30-14;
SSP 38-2013, f. 12-31-13, cert. ef. 1-1-14
461-160-0193
Determining Eligibility and Calculating Payment; Direct Provider Payments for TANF Child Care
(1) Clients in the
TANF program are eligible for direct provider payments for child care (see OAR 461-165-0160)
if:
(a) The child
care cost is deductible under OAR 461-160-0040;
(b) The caretaker
relative is employed and is in the financial group. For the purpose of this rule,
work study and a job with earnings that are excluded for the TANF program are not
considered employment; and
(c) The child
meets the age requirements of OAR 461-120-0510.
(2) Payments
are limited as follows:
(a) The cost
must be allowed by OAR 461-160-0040;
(b) Payment
is limited to the rates provided in OAR 461-155-0150;
(c) The direct
child care payment is calculated in accordance with OAR 461-160-0300; and
(d) Payment
is made only for child care already provided.
Stat. Auth.: ORS
411.060

Stats. Implemented:
ORS 411.060 & 411.083

Hist.: AFS
20-1992, f. 7-31-92, cert. ef. 8-1-92; AFS 22-1992(Temp), f. & cert. ef. 8-10-92;
AFS 28-1992, f. & cert. ef. 10-1-92; AFS 16-1993, f. & cert. ef. 9-1-93;
AFS 10-1995, f. 3-30-95, cert. ef. 4-1-95; AFS 9-1997, f. & cert. ef. 7-1-97;
AFS 3-2000, f. 1-31-00, cert. ef. 2-1-00; SSP 7-2003, f. & cert. ef. 4-1-03;
SSP 8-2013, f. & cert. ef. 4-1-13
461-160-0300
Use of Income to Determine Eligibility and Benefits for ERDC
The Department determines financial
eligibility for ERDC and the benefit level as follows:
(1) The monthly income of
the financial group (see OAR 461-110-0530) is determined in accordance with OAR
461-150-0060.
(2) The monthly income at
initial certification and recertification is compared to the ERDC eligibility standards
in OAR 461-155-0150(5). If monthly income equals or exceeds the eligibility standards,
the need group is ineligible for ERDC. If monthly income does not exceed the eligibility
standard, the client's eligibility is determined under section (3) of this rule.
(3) For a client found eligible
under section (2) of this rule, the allowable child care cost and the client's copay
are determined as follows:
(a) The child care costs
for which the client has been billed are compared to the amount provided in the
appropriate child care chart in OAR 461-155-0150. The allowable child care cost
is the lesser of the two amounts.
(b) The need group's copay
is determined in accordance with OAR 461-155-0150.
(4) The copay is subtracted
from the allowable child care cost, and the remainder is the payment the Department
makes to the provider. If the copay is equal to or greater than the allowable child
care cost, the client is not eligible for ERDC. If the copay is less than the allowable
child care cost, the client meets the income requirement for ERDC.
Stat. Auth.: ORS 411.060
Stats. Implemented: ORS 411.060
& 411.122
Hist.: AFS 80-1989, f. 12-21-89,
cert. ef. 2-1-90; AFS 12-1990, f. 3-30-90, cert. ef. 4-1-90; AFS 17-1990(Temp),
f. 6-29-90, cert. ef. 7-1-90; AFS 26-1990, f. & cert. ef. 11-29-90; AFS 30-1990,
f. 12-31-90, cert. ef. 1-1-91; AFS 9-1991, f. 3-29-91, cert. ef. 4-1-91; AFS 20-1992,
f. 7-31-92, cert. ef. 8-1-92; AFS 12-1993, f. & cert. ef. 7-1-93; AFS 2-1994,
f. & cert. ef. 2-1-94; AFS 34-2000, f. 12-22-00, cert. ef. 1-1-01; SSP 13-2009,
f. & cert. ef. 7-1-09; SSP 29-2015(Temp), f. & cert. ef. 10-1-15 thru 3-28-16
461-160-0400
Use of Income to Determine Eligibility and Benefits; SNAP
In the SNAP program, the countable income (see OAR 461-140-0010) and adjusted income (see OAR 461-001-0000) of the financial group (see OAR 461-110-0530) are used to determine eligibility for SNAP benefits and the benefit level in three steps:
(1) Step one: The countable income of the financial group is compared to the need group's countable income limit in OAR 461-155-0190. If the income equals or exceeds the limit, the need group (see 461-110-0630) is ineligible for SNAP benefits. A financial group that is categorically eligible (see 461-135-0505) for SNAP benefits or that includes a client who is elderly (see 461-001-0015) or has a disability (see 461-001-0015) need not pass this step.
(2) Step two: If the need group is not ineligible under step one, the adjusted income of the financial group is compared to the need group's adjusted income limit (see OAR 461 155 0190). If the income equals or exceeds the limit, the filing group — except one that is categorically eligible for SNAP benefits — is ineligible for SNAP benefits. If the adjusted income is less than the limit, the need group meets the income standard for the SNAP program.
(3) Step three: The benefit level for an eligible need group is determined as follows — adjusted income is multiplied by 30 percent, and the product is rounded to the next higher dollar. The result is subtracted from the need group's payment standard (see OAR 461-155-0190). The remainder is the benefit amount.
Stat. Auth.: ORS 411.816

Stats. Implemented: ORS 411.816

Hist.: AFS 80-1989, f. 12-21-89, cert. ef. 2-1-90; AFS 8-1992, f. & cert. ef. 4-1-92; AFS 10-2002, f. & cert. ef. 7-1-02; SSP 15-2006, f. 12-29-06, cert. ef. 1-1-07; SSP 32-2010, f. & cert. ef. 10-1-10; SSP 37-2010(Temp), f. & cert. ef. 11-1-10 thru 4-30-11; SSP 10-2011, f. 3-31-11, cert. ef. 4-1-11
461-160-0410
Use of Income and Income Deductions When There Are Ineligible or Disqualified Group Members; SNAP
When a member of the filing group (see
OAR 461-110-0370) is not in the need group (see OAR 461-110-0630), benefits in the
SNAP program are calculated as follows:
(1) If the member is a qualified
non-citizen (see OAR 461-120-0125(1)(a)–(g)) who does not meet the alien status
requirements, the following procedure is used:
(a) Benefits are calculated
as if the qualified non-citizen is eligible. Benefits are then calculated as if
the qualified non-citizen is not a member of the filing group. Any income received
by another member of the filing group from the qualified non-citizen is counted
as income of the filing group. No expenses paid by the qualified non-citizen are
deducted from gross income.
(b) The household's benefits
are the lesser of the amounts calculated in subsection (a) of this section.
(2) The process described
in sections (3) and (4) of this rule is used if the member is:
(a) A non-citizen but not
a qualified non-citizen;
(b) Disqualified for failing
to obtain or provide a Social Security Number; or
(c) Unwilling to disclose
alien status.
(3) If the member is in a
group described in section (2) of this rule:
(a) The member's countable
(see OAR 461-001-0000) income is prorated among the members in the filing group.
(b) The pro rata share of
each individual not in the benefit group (see OAR 461-110-0750) is excluded.
(c) The rest of the prorated
income is countable income for the filing group.
(4) An ineligible or disqualified
member covered by section (2) of this rule is entitled to all income deductions
for which the member qualifies. When paid by the member, or billed to the member
and unpaid, deductions for shelter, child support, medical costs, and dependent
care are calculated as follows:
(a) The deductions, except
deductions for the utility standard, are prorated among the members of the filing
group.
(b) The prorated share of
the members of the benefit group is deducted.
(c) The deduction for the
utility standard is made in accordance with OAR 461-160-0420.
(5) The countable income
of the following financial group (see OAR 461-110-0530) members, subject to allowable
deductions, is used to determine benefits:
(a) A client disqualified
for failure to comply with the requirements of the OFSET program or because of an
intentional program violation.
(b) A client:
(A) Fleeing to avoid prosecution,
or custody or confinement after conviction, under the law of the place from which
the client is fleeing, for a crime, or attempt to commit a crime, that is a felony
under the law of the place from which the client is fleeing or that, in the case
of New Jersey, is a high misdemeanor under the law of New Jersey; or
(B) Violating a condition
of probation or parole imposed under a federal or state law.
Stat. Auth.: ORS 409.050, 411.060, 411.070,
411.816
Stats. Implemented: ORS 409.010,
409.050, 411.060, 411.070, 411.816, 411.837
Hist.: 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 23-1990, f. 9-28-90,
cert. ef. 10-1-90; AFS 20-1991, f. & cert. ef. 10-1-91; AFS 6-1994, f. &
cert. ef. 4-1-94; AFS 23-1994, f. 9-29-94, cert. ef. 10-1-94; AFS 22-1995, f. 9-20-95,
cert. ef. 10-1-95; AFS 27-1996, f. 6-27-96, cert. ef. 7-1-96; AFS 42-1996, f. 12-31-96,
cert. ef. 1-1-979; AFS 12-2000(Temp), f. 5-1-00, cert. ef. 5-1-00 thru 9-30-00;
AFS 25-2000, f. 9-29-00, cert. ef. 10-1-00; AFS 10-2001(Temp), f. 6-29-01, cert.
ef. 7-1-01 thru 10-1-01; AFS 19-2001, f. 8-31-01, cert. ef. 9-1-01; AFS 5-2002,
f. & cert. ef. 4-1-02; AFS 6-2002(Temp), f. & cert. ef. 4-1-02 thru 6-30-02;
AFS 10-2002, f. & cert. ef. 7-1-02; SSP 23-2003, f. & cert. ef. 10-1-03;
SSP 6-2006, f. 3-31-06, cert. ef. 4-1-06; SSP 14-2007, f. 12-31-07, cert. ef. 1-1-08;
SSP 26-2008, f. 12-31-08, cert. ef. 1-1-09; SSP 5-2009, f. & cert. ef. 4-1-09;
SSP 41-2010, f. 12-30-10, cert. ef. 1-1-11; SSP 8-2013, f. & cert. ef. 4-1-13;
SSP 20-2015(Temp), f. & cert. ef. 7-1-15 thru 12-27-15; SSP 28-2015, f. 9-29-15,
cert. ef. 10-1-15
461-160-0415
Medical Deduction;
SNAP
(1) This rule explains
how to calculate the deduction for medical costs in the SNAP program allowed under
OAR 461-160-0055 when incurred by an elderly (see 461-001-0015) member of
the filing group (see 461-110-0370) or by a filing group member with
a disability (see 461-001-0015).
(2) For each certification period (see OAR 461-001-0000), the Department estimates the
amount of the client's medical deduction and apportions the amount evenly among
the months in the certification period. For medical costs payable during
the month of certification, the client may choose to deduct each cost in the month
of certification or to average the cost over the certification period.
(3) For medical
costs that were not anticipated when the deduction was estimated but are incurred
and reported to the Department during the certification period, the client
may choose to deduct each cost:
(a) In the
month after the cost is reported; or
(b) By averaging
the cost over the period from the month after the cost was reported to the end of
the certification period.
(4) If the
client is billed in the last month of a certification period for a medical
cost that is due after the certification period, and the client does not
pay the bill during the certification period, the cost may be used to compute
the deduction in the next certification period.
(5) Medical
costs paid with a credit card are treated the same as if the cost were paid in full.
The ongoing credit card payments are not an allowable medical deduction.
(6) A medical
cost is not deductible in any of the following situations:
(a) The client
reports a paid medical cost in the last month of the redetermination period, but
reports this cost after their benefits for that month have already been issued.
(b) The medical
cost is past due, is an amount carried forward from a previous billing period, or
has been paid by the client in a previous certification period.
(c) The client
and creditor have agreed on a monthly payment amount, but the client defaults on
the agreement.
Stat. Auth.: ORS
411.816

Stats. Implemented:
ORS 411.816

Hist.: AFS
13-1991, f. & cert. ef. 7-1-91; AFS 19-1993, f. & cert. ef. 10-1-93; AFS
23-2000(Temp), f. 9-29-00, cert. ef. 10-1-00 thru 12-31-00; Suspended by AFS 31-2000(Temp),
f. & cert. ef. 12-1-00 thru 12-31-00; AFS 34-2000, f. 12-22-00, cert. ef. 1-1-01;
SSP 10-2006, f. 6-30-06, cert. ef. 7-1-06; SSP 15-2006, f. 12-29-06, cert. ef. 1-1-07;
SSP 14-2007, f. 12-31-07, cert. ef. 1-1-08; SSP 8-2013, f. & cert. ef. 4-1-13
461-160-0420
Shelter Cost;
SNAP
(1) This rule explains how to calculate
the shelter cost. The shelter cost is used to determine the shelter deduction (see
OAR 461-160-0430). The shelter cost is the sum of the filing group's cost of housing
plus an allowance for utilities, if the individual incurs a utility cost. The shelter
deduction is based on the shelter cost but is subject to a limitation described
in OAR 461-160-0430.
(2) Cost of housing.
(a) The following comprise
the cost of housing if they are incurred with respect to the filing group's current
residence or the home described in section (5) of this rule:
(A) Regular, periodic charges
for the shelter of the filing group (see OAR 461-110-0370), such as rent, mortgage
payments, and condominium or association fees. Late fees charged because a mortgage
or rent payment was made late are not deductible.
(B) Property taxes, state
and local assessments, and property insurance on the structure.
(C) Costs for repairing a
home substantially damaged or destroyed by a natural disaster (such as a fire or
flood), if such costs are not reimbursed.
(D) If the filing group is
homeless and living in a vehicle — vehicle payments and collision and comprehensive
insurance premiums for the vehicle.
(b) If housing costs are
billed on a weekly or biweekly basis, the monthly cost is the weekly cost multiplied
by 4.3 or the biweekly cost multiplied by 2.15.
(c) The filing group has
the following choices about housing costs:
(A) The group may choose
to apply the cost in the month it is billed or becomes due.
(B) The group may choose
to have periodic costs averaged.
(C) For expenses that are
billed less often than monthly, the group may choose to have them averaged over
the period they are intended to cover.
(3) Shared housing. If the
filing group shares housing costs with an individual in the dwelling who is not
in the filing group, only the housing costs incurred by the filing group are included
in the calculation. If the portion paid by an individual outside the filing group
cannot be ascertained, the cost is apportioned among the individuals contributing
to the cost. The pro rata share of those not in the filing group is deducted from
the total, and the balance is considered a housing cost of the filing group.
(4) Cost for utilities.
(a) A filing group has a
cost for utilities if it incurs a cost for heating or cooling; cooking fuel; electricity;
water and sewerage; well installation and maintenance; septic tank system installation
and maintenance; garbage and trash collection; service for a telephone, such as
basic service fee, wire maintenance, subscriber line charges, relay center surcharges,
911 service, and taxes; or initial installation fees charged by a utility provider.
(b) If the group incurs no
cost for utilities in either its current home or in the home described in section
(5) of this rule, then the shelter cost is calculated without an allowance for utilities.
(c) If a homeless filing
group uses a vehicle for shelter, the cost of fuel for the vehicle is considered
a utility cost.
(d) If a filing group incurs
a cost for utilities, then the utility allowance is one of the following:
(A) Allowance with heating
or cooling. A full standard utility allowance of $445 per month is used if the household
group (see OAR 461-110-0210) is billed for heating or cooling costs for its dwelling.
Charges for any fuel and for electricity are considered heating costs if they are
used for heating. A filing group who receives an energy assistance payment for the
dwelling provided through the Low Income Energy Assistance Act of 1981 is eligible
for the utility allowance established by this paragraph (A). This energy assistance
payment must be greater than $20 annually.
(B) Allowance without heating
or cooling.
(i) A limited standard utility
allowance of $327 per month is used if the filing group is not billed for heating
or cooling costs but is billed for at least two other costs enumerated in subsection
(4)(a) of this rule.
(ii) An individual standard
utility allowance of $55 per month is used if the filing group is not billed for
heating or cooling costs but is billed for only one of the costs enumerated in subsection
(4)(a) of this rule other than the service cost for a telephone, including the related
taxes or fees.
(iii) A telephone standard
utility allowance of $60 per month is used if the filing group is billed only for
telephone service, such as basic service fee, wire maintenance, subscriber line
charges, relay center surcharges, 911 service, and taxes.
(5) Housing costs for a home
not occupied by the filing group. Housing and utility costs with respect to a home
not currently occupied may be considered in calculating the shelter cost if:
(a) The home is temporarily
unoccupied because of employment or training away from home, illness, or abandonment
caused by casualty or natural disaster;
(b) The filing group intends
to return to the home;
(c) No other, current occupant
is claiming a deduction for shelter costs in the SNAP program; and
(d) The home is not leased
during the household's absence.
Stat. Auth.: ORS 409.050, 411.060, 411.070,
411.816
Stats. Implemented: ORS 409.010,
409.050, 411.060, 411.070, 411.816, 411.825, 411.837
Hist.: AFS 80-1989, f. 12-21-89,
cert. ef. 2-1-90; AFS 1-1991(Temp), f. & cert. ef. 1-2-91; AFS 13-1991, f. &
cert. ef. 7-1-91; AFS 8-1992, f. & cert. ef. 4-1-92; AFS 19-1993, f. & cert.
ef. 10-1-93; AFS 13-1994, f. & cert. ef. 7-1-94; AFS 23-1994, f. 9-29-94, cert.
ef. 10-1-94; AFS 13-1995, f. 6-29-95, cert. ef. 7-1-95; AFS 34-1996, f. 9-26-96,
cert. ef. 10-1-96; AFS 19-1997, f. & cert. ef. 10-1-97; AFS 21-1998(Temp), f.
10-15-98 & cert. ef. 11-1-98 thru 12-31-98; AFS 25-1998, f. 12-28-98, cert.
ef. 1-1-99; AFS 25-2000, f. 9-29-00, cert. ef. 10-1-00; AFS 9-2001, f. & cert.
ef. 6-1-01; AFS 22-2001, f. & cert. ef. 10-1-01; AFS 13-2002, f. & cert.
ef. 10-1-02; SSP 23-2003, f. & cert. ef. 10-1-03; SSP 22-2004, f. & cert.
ef. 10-1-04; SSP 14-2005, f. 9-30-05, cert. ef. 10-1-05; SSP 14-2006, f. 9-29-06,
cert. ef. 10-1-06; SSP 10-2007, f. & cert. ef. 10-1-07; SSP 23-2008, f. &
cert. ef. 10-1-08; SSP 28-2009, f. & cert. ef. 10-1-09; SSP 32-2010, f. &
cert. ef. 10-1-10; SSP 25-2011, f. 9-30-11, cert. ef. 10-1-11; SSP 30-2012, f. 9-28-12,
cert. ef. 10-1-12; SSP 8-2013, f. & cert. ef. 4-1-13; SSP 24-2013, f. &
cert. ef. 10-1-13; SSP 13-2014(Temp), f. & cert. ef. 5-20-14 thru 11-16-14;
SSP 24-2014, f. & cert. ef. 10-1-14; SSP 28-2015, f. 9-29-15, cert. ef. 10-1-15
461-160-0430
Income Deductions; SNAP
(1) Deductions from income are subtracted
from countable (see OAR 461-001-0000) income (see 461-140-0010) in the following
order to determine adjusted income (see 461-001-0000) for the SNAP program:
(a) An earned income deduction
of 20 percent of countable earned income. The 20 percent deduction is not taken
from the wages funded by grant diversions such as Work Supplementation wages.
(b) A standard deduction
of:
(A) $155 per month for a
benefit group (see OAR 461-110-0750) of one, two, or three individuals.
(B) $168 per month for a
benefit group of four individuals.
(C) $197 per month for a
benefit group of five individuals.
(D) $226 per month for a
benefit group of six or more individuals.
(c) A dependent care deduction
for dependent care costs billed to a member of the filing group (see OAR 461-110-0370)
and not paid for through any other program of the Department. For the cost to be
deductible under this section, the care must be necessary to enable a member of
the filing group to:
(A) Accept or continue employment;
(B) Seek employment, including
a job search that meets the requirements of a case plan (see OAR 461-001-0020);
or
(C) Attend vocational or
educational training. A student receiving educational income is entitled to a deduction
only for costs not excluded from educational income by OAR 461-145-0150.
(d) The medical deduction
for elderly (see OAR 461-001-0015) individuals and individuals who have a disability
(see 461-001-0015) in the filing group. The deduction is calculated by determining
the total of their deductible medical costs (see 461-160-0415) and subtracting $35.
The remainder is the medical deduction.
(e) A deduction for child
support payments (including cash medical support) a member of the filing group makes
under a legal obligation to a child (see OAR 461-001-0000) not a member of the filing
group, including payments for the current month and for payments on arrearages.
Child support is not deductible if collected by setoff through the Oregon Department
of Revenue or by interception of a federal tax refund.
(f) A shelter deduction,
calculated as follows:
(A) For SNAP filing group
members required to pay room and board in a nonstandard living arrangement (see
OAR 461-001-0000), the shelter deduction is:
(i) The cost of room and
board, minus the payment standard for the benefit group; or
(ii) The actual room cost,
if the individual can prove that the room cost exceeds the cost described in subparagraph
(i) of this paragraph.
(B) For all other filing
group members, the shelter deduction is calculated as follows:
(i) The standard deduction
and the deductions of earned income, dependent care, court-ordered child support,
and medical expenses are subtracted from countable income. Fifty percent of the
remainder is subtracted from the shelter cost calculated in accordance with OAR
461-160-0420.
(ii) The rounded balance
is the deduction, except the deduction is limited if the filing group has no member
who has a disability or is elderly. The limit is $490 per month.
(2) If a filing group member
cannot verify a medical or court-ordered child-support expense or cannot verify
any other expense when asked to do so, the unverified expense is not used to calculate
the deduction. If the individual provides verification, the deduction is applied
when calculating the next month's benefits. If verification is provided within the
period authorized for processing applications (see OAR 461-115-0210), the benefits
for the initial month (see OAR 461-001-0000) are recalculated using the deduction.
Stat. Auth.: ORS 409.050, 411.060, 411.070,
411.816
Stats. Implemented: ORS 409.010,
409.050, 411.060, 411.070, 411.816, 411.825, 411.837
Hist.: AFS 80-1989, f. 12-21-89,
cert. ef. 2-1-90; AFS 12-1990, f. 3-30-90, cert. ef. 4-1-90; AFS 23-1990, f. 9-28-90,
cert. ef. 10-1-90; AFS 13-1991, f. & cert. ef. 7-1-91; AFS 20-1991, f. &
cert. ef. 10-1-91; AFS 8-1992, f. & cert. ef. 4-1-92; AFS 28-1992, f. &
cert. ef. 10-1-92; AFS 19-1993, f. & cert. ef. 10-1-93; AFS 13-1994, f. &
cert. ef. 7-1-94; AFS 19-1994, f. & cert. ef. 9-1-94; AFS 23-1994, f. 9-29-94,
cert. ef. 10-1-94; AFS 10-1995, f. 3-30-95, cert. ef. 4-1-95; AFS 22-1995, f. 9-20-95,
cert. ef. 10-1-95; AFS 27-1995(Temp), f. 10-30-95, cert. ef. 11-1-95; AFS 41-1995,
f. 12-26-95, cert. ef. 1-1-96; AFS 27-1996, f. 6-27-96, cert. ef. 7-1-96; AFS 31-1996,
f. & cert. ef. 9-23-96; AFS 41-1996(Temp), f. & cert. ef. 12-31-96; AFS
3-1997, f. 3-31-97, cert. ef. 4-1-97; AFS 19-1997, f. & cert. ef. 10-1-97; AFS
4-1998, f. 2-25-98, cert. ef. 3-1-98; AFS 5-1998(Temp), f. & cert. ef. 3-11-98
thru 5-31-98; AFS 8-1998, f. 4-28-98, cert. ef. 5-1-98; AFS 15-1998(Temp), f. 9-15-98,
cert. ef. 10-1-98 thru 10-31-98; AFS 22-1998, f. 10-30-98, cert. ef. 11-1-98; AFS
2-1999, f. 3-26-99, cert. ef. 4-1-99; AFS 23-2000(Temp), f. 9-29-00, cert. ef. 10-1-00
thru 12-31-00; AFS 25-2000, f. 9-29-00, cert. ef. 10-1-00; AFS 23-2000(Temp) Suspended
by AFS 28-2000(Temp), f.10-31-0, cert. ef. 11-1-00 thru 12-31-00; AFS 34-2000, f.
12-22-00, cert. ef. 1-1-01; AFS 3-2001, f. 2-27-01, cert. ef. 3-1-01; AFS 22-2001,
f. & cert. ef. 10-1-01; AFS 13-2002, f. & cert. ef. 10-1-02; SSP 23-2003,
f. & cert. ef. 10-1-03; SSP 17-2004, f. & cert. ef. 7-1-04; SSP 22-2004,
f. & cert. ef. 10-1-04; SSP 14-2005, f. 9-30-05, cert. ef. 10-1-05; SSP 14-2006,
f. 9-29-06, cert. ef. 10-1-06; SSP 15-2006, f. 12-29-06, cert. ef. 1-1-07; SSP 10-2007,
f. & cert. ef. 10-1-07; SSP 11-2007(Temp), f. & cert. ef. 10-1-07 thru 3-29-08;
SSP 5-2008, f. 2-29-08, cert. ef. 3-1-08; SSP 23-2008, f. & cert. ef. 10-1-08;
SSP 28-2009, f. & cert. ef. 10-1-09; SSP 39-2010(Temp), f. & cert. ef. 11-4-10
thru 5-3-11; SSP 41-2010, f. 12-30-10, cert. ef. 1-1-11; SSP 43-2010(Temp), f. 12-30-10,
cert. ef. 1-1-11 thru 4-30-11; SSP 10-2011, f. 3-31-11, cert. ef. 4-1-11; SSP 25-2011,
f. 9-30-11, cert. ef. 10-1-11; SSP 30-2012, f. 9-28-12, cert. ef. 10-1-12; SSP 8-2013,
f. & cert. ef. 4-1-13; SSP 24-2013, f. & cert. ef. 10-1-13; SSP 24-2014,
f. & cert. ef. 10-1-14; SSP 28-2015, f. 9-29-15, cert. ef. 10-1-15
461-160-0500
Use of Income To Determine Eligibility and Benefits; GA, GAM
In the GA and GAM programs, the countable and adjusted income (see OAR 461-001-0000) of a financial group (see OAR 461-110-0530) are used to determine eligibility and benefit amount as follows:
(1) If the countable income of the financial group equals or exceeds the payment standard for the need group (see OAR 461-110-0630), the need group is ineligible for GA and GAM. If the countable income is less than the standard, the need group meets the income standard for GA and GAM.
(2) The benefit amount is determined by subtracting the adjusted income of the financial group from the sum of the payment standard for the need group and its ongoing special needs.
(3) The benefit cannot exceed the sum of the payment standard for the benefit group (see OAR 461-110-0750) plus the ongoing special needs.
Stat. Auth.: ORS 411.060 & 411.710

Stats. Implemented: ORS 411.060 & 411.710

Hist.: AFS 80-1989, f. 12-21-89, cert. ef. 2-1-90; AFS 17-1995, f. 7-31-94, cert. ef. 8-1-95; AFS 23-1995, f. 9-20-95, cert. ef. 10-1-95; AFS 8-1998, f. 4-28-98, cert. ef. 5-1-98; AFS 9-1999, f. & cert. ef. 7-1-99; AFS 10-2002, f. & cert. ef. 7-1-02; SSP 29-2003(Temp), f. 10-31-03, cert. ef. 11-1-03 thru 3-31-04; SSP 6-2004, f. & cert. ef. 4-1-04; SSP 15-2006, f. 12-29-06, cert. ef. 1-1-07
461-160-0540
Determining Financial Eligibility and Benefits; QMB and OSIPM (except OSIPM-EPD) Living in the Community
(1) This rule is used to determine financial
eligibility for QMB program clients and OSIPM (except OSIPM-EPD) program clients
who:
(a) Live in the community;
(b) Do not receive SSI; and
(c) Do not receive home and
community-based care (see OAR 461-001-0030).
(2) In the OSIPM program,
to determine eligibility for clients 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, the amount of the service payment
is added to the adjusted income standard defined in 461-155-0250. The sum of
the service payment and the OSIPM program adjusted income standard must be greater
than the client's adjusted income. If the sum of the service payment and the OSIPM
program standard is less than the adjusted income, the client is not eligible. For
all other OSIPM program clients, they are eligible if their adjusted income is less
than the OSIPM program standard.
(3) In the QMB-BAS program,
a client is eligible if his or her adjusted income is equal to or less than the
QMB program adjusted income standard.
(4) In the QMB-SMB program,
a client is eligible if his or her adjusted income is less than the adjusted income
standard.
Stat. Auth.: ORS 411.060, 411.070, 411.404,
411.706
Stats. Implemented: ORS 411.060,
411.070, 411.404, 411.706
Hist.: 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
461-160-0550
Income Deductions; Non-SSI OSIP (except OSIP-EPD) and OSIPM (except OSIPM-EPD) in the Community When There Are No Children in the Household Group
(1) For purposes of this rule:
(a) A "child" is an unmarried
individual, living with a natural or adoptive parent, and is:
(A) Under the age of 18;
or
(B) Under the age of 22 and
attending full-time secondary, postsecondary, or vocational-technical training designed
to prepare the individual for employment.
(b) “Ineligible”
means an individual who is not eligible to receive either SSI or TANF benefits.
(2) This rule is used to
determine adjusted income (see OAR 461-001-0000) for all individuals in the OSIP
(except OSIP-EPD) and OSIPM (except OSIPM-EPD) programs who:
(a) Live in the community;
(b) Are not assumed eligible
(see OAR 461-135-0010);
(c) Do not receive home and
community-based care (see OAR 461-001-0030); and
(d) Do not have at least
one child (see section (1) of this rule) in the household group (see OAR 461-110-0210).
(3) For an individual described
in section (2) of this rule who is married to a spouse (see OAR 461-001-0000) who
is ineligible (see section (1) of this rule), the Department calculates the adjusted
income of the individual under subsections (4)(a) through (4)(e) of this rule first.
If the individual’s adjusted income is greater than the OSIPM program adjusted
income standard for a need group of one under 461-155-0250, the individual is not
eligible for OSIPM.
(4) To determine adjusted
income for individuals described in section (2) of this rule, deductions from the
countable (see OAR 461-001-0000) income of the financial group (see OAR 461-110-0530)
are made in the following order:
(a) One standard deduction
of $20 from unearned income. This deduction may be taken from earned income if the
individual has less than $20 in unearned income.
(b) One standard earned income
deduction of:
(A) $65 for OSIP-AD, OSIP-OAA,
OSIPM-AD, and OSIPM-OAA clients who are not blind; or
(B) $85 for OSIP-AB and OSIPM-AB
clients who are blind.
(c) An income deduction for
documented impairment-related work expenses or blind work expenses.
(d) One half of the remaining
earned income.
(e) Deductions under a plan
for self-support.
Stat. Auth.: ORS 411.060, 411.070 &
414.042
Stats. Implemented: ORS 411.060,
411.070 & 414.042
Hist.: 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 28-1992, f. &
cert. ef. 10-1-92; AFS 10-1995, f. 3-30-95, cert. ef. 4-1-95; 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 25-2000, f. 9-29-00, cert. ef. 10-1-00; AFS 6-2001, f. 3-30-01, cert. ef. 4-1-01;
AFS 13-2002, f. & cert. ef. 10-1-02; SSP 29-2003(Temp), f. 10-31-03, cert. ef.
11-1-03 thru 3-31-04; SSP 6-2004, f. & cert. ef. 4-1-04; SSP 24-2004, f. 12-30-04,
cert. ef. 1-1-05; SSP 14-2007, f. 12-31-07, cert. ef. 1-1-08; SSP 17-2008, f. &
cert. ef. 7-1-08; SSP 23-2008, f. & cert. ef. 10-1-08; SSP 25-2008(Temp), f.
12-31-08, cert. ef. 1-1-09 thru 6-30-09; SSP 5-2009, f. & cert. ef. 4-1-09;
SSP 13-2009, f. & cert. ef. 7-1-09; SSP 17-2013(Temp), f. & cert. ef. 7-1-13
thru 12-28-13; SSP 26-2013, f. & cert. ef. 10-1-13; SSP 15-2014, f. & cert.
ef. 7-1-14
461-160-0551
Income Deductions; Non-SSI OSIP
(except OSIP-EPD) and OSIPM (except OSIPM-EPD) in the Community When There Are Children
in the Household Group
(1) For purposes of this rule:
(a) A “child”
is an unmarried individual, living with a natural or adoptive parent, and is:
(A) Under the age of 18;
or
(B) Under the age of 22 and
attending full-time secondary, postsecondary, or vocational-technical training designed
to prepare the individual for employment.
(b) “Ineligible”
means an individual who is not eligible to receive either SSI or TANF benefits.
(2) This rule is used to
determine adjusted income (see OAR 461-001-0000) for clients in the OSIP (except
OSIP-EPD) and OSIPM (except OSIPM-EPD) programs who:
(a) Live in the community;
(b) Are not assumed eligible
(see OAR 461-135-0010);
(c) Do not receive home and
community-based care (see OAR 461-001-0030); and
(d) Have at least one child
(see section (1) of this rule) in the household group (see OAR 461-110-0210).
(3) For an individual described
in section (2) of this rule who is married to a spouse (see OAR 461-001-0000) who
is ineligible (see section (1) of this rule), the Department calculates the adjusted
income of the individual under sections (4)(b) through (f) of this rule first. If
the individual’s adjusted income is greater than the OSIPM program adjusted
income standard for a need group of one under OAR 461-155-0250, the individual is
not eligible for OSIPM.
(4) To determine adjusted
income for clients described in section (2) of this rule, deductions from the countable
(see OAR 461-001-0000) income of the financial group (see OAR 461-110-0530) are
made in the following order:
(a) An allocation as described
below:
(A) When an adult is applying,
income is allocated (see paragraph (C) of this subsection) from an ineligible spouse
included in the financial group to each ineligible child of the couple.
(B) When a child is applying:
(i) Income from ineligible
parents is first allocated to each ineligible child in the household.
(ii) Second, the remaining
income from subparagraph (i) of this paragraph is reduced as provided in subsections
(b) through (f) of this section.
(iii) Third, the remaining
income is reduced by the non-SSI OSIP and OSIPM adjusted income standard of the:
(I) Couple if both parents
live with the child; or
(II) Individual if only one
ineligible parent lives with the child.
(iv) Fourth, the remainder
is deemed equally to each child applicant in the household.
(v) The income deemed to
the child is added to the other income of the child and deductions are taken as
described in subsections (b) through (f) of this section to calculate the child's
adjusted income.
(C) The maximum amount of
each allocation under paragraphs (A) and (B) of this subsection is the difference
between the couple and the individual SSI Standard. The allocation for paragraphs
(A) and (B) of this subsection is reduced by the other countable income of each
ineligible child. An allocation is taken from unearned income first, and any remaining
allocation is then taken from earned income.
(b) One standard deduction
of $20 from unearned income. This deduction may be taken from earned income if the
client has less than $20 in unearned income.
(c) One standard earned income
deduction of:
(A) $65 for clients in the
OSIP-AD, OSIP-OAA, OSIPM-AD, and OSIPM-OAA programs; or
(B) $85 for clients in the
OSIP-AB and OSIPM-AB programs.
(d) An income deduction for
documented impairment-related work expenses or blind work expenses.
(e) One half of the remaining
earned income.
(f) Deductions under a plan
for self-support for clients in the OSIP-AB, OSIP-AD, OSIPM-AB, and OSIPM-AD programs.
Stat. Auth.: ORS 411.060, 411.070, 414.042
Stats. Implemented: ORS 411.060,
411.070, 414.042
Hist.: SSP 17-2008, f. &
cert. ef. 7-1-08; SSP 23-2008, f. & cert. ef. 10-1-08; SSP 25-2008(Temp), f.
12-31-08, cert. ef. 1-1-09 thru 6-30-09; SSP 5-2009, f. & cert. ef. 4-1-09;
SSP 13-2009, f. & cert. ef. 7-1-09; SSP 17-2013(Temp), f. & cert. ef. 7-1-13
thru 12-28-13; SSP 26-2013, f. & cert. ef. 10-1-13; SSP 15-2014, f. & cert.
ef. 7-1-14
461-160-0552
Income Deductions; Qualified Medicare Beneficiaries Programs
(1) This rule is used to determine adjusted income for the Qualified Medicare Beneficiaries programs: QMB-BAS and QMB-SMB (including SMF) programs.
(2) To determine adjusted income, deductions from the countable income of the financial group (see OAR 461-110-0530) are made in the following order:
(a) One standard deduction of $20 from unearned income. This deduction may be taken from earned income if the client has less than $20 in unearned income.
(b) One standard earned income deduction of:
(A) $65 for clients who are not blind; or
(B) $85 for clients who are blind.
(c) An income deduction for documented impairment-related work expenses or blind work expenses for clients under age 65.
(d) One half of the remaining earned income.
(e) Deductions under a plan for self-support for clients less than the age of 65.
Stat. Auth.: ORS 411.060, 411.070, 414.042

Stats. Implemented: ORS 411.060, 411.070, 414.042

Hist.: SSP 23-2008, f. & cert. ef. 10-1-08
461-160-0570
Excluded Resource; Community Spouse Provision Before 10/1/89
For OSIP and OSIPM, if the institutionalized spouse began a continuous period of care before October 1, 1989:
(1) Count the resources owned by the institutionalized spouse.
(2) Count resources jointly owned by both spouses according to rules on availability of resources.
(3) Do not count the resources owned solely by the community spouse.
Stat. Auth.: ORS 411.060, 411.070, 411.404 & 411.706

Stats. Implemented: ORS 411.060, 411.070, 411.083, 411.404, 411.704 & 411.706

Hist.: AFS 80-1989, f. 12-21-89, cert. ef. 2-1-90
461-160-0580
Excluded Resource; Community Spouse Provision (OSIPM except OSIPM-EPD)
In the OSIPM (except OSIPM-EPD)
program:
(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 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 clients.
(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 $119,220.
(B) $23,844 (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 client became an institutionalized spouse on
or after February 8, 2006, this resource allowance must use all of the client'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 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).
(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(3)(a)). 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 $119,220) plus the OSIPM resource
standard for one person.
(B) $23,844 (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 his or her 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 client.
Stat. Auth.: ORS 411.060, 411.070, 411.083,
411.404 & 411.706
Stats. Implemented: ORS 411.060,
411.070, 411.083, 411.404 & 411.706
Hist.: AFS 80-1989, f. 12-21-89,
cert. ef. 2-1-90; AFS 16-1990, f. 6-29-90, cert. ef. 7-1-90; AFS 3-1991(Temp), f.
& cert. ef. 1-17-91; AFS 13-1991, f. & cert. ef. 7-1-91; AFS 8-1992, f.
& cert. ef. 4-1-92; AFS 5-1993, f. & cert. ef. 4-1-93; AFS 29-1993, f. 12-30-93,
cert. ef. 1-1-94; AFS 29-1994, f. 12-29-94, cert. ef. 1-1-95; AFS 41-1995, f. 12-26-95,
cert. ef. 1-1-96; AFS 42-1996, f. 12-31-96, cert. ef. 1-1-97; AFS 24-1997, f. 12-31-97,
cert. ef. 1-1-98; AFS 25-1998, f. 12-28-98, cert. ef. 1-1-99; 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 9-1999, f. & cert. ef. 7-1-99; AFS 9-1999, f. & cert. ef. 7-1-99; AFS
11-1999, f. & cert. ef. 10-1-99; AFS 16-1999, f. 12-29-99, cert. ef. 1-1-00;
AFS 25-2000, f. 9-29-00, cert. ef. 10-1-00; AFS 34-2000, f. 12-22-00, cert. ef.
1-1-01; AFS 27-2001, f. 12-21-01, cert. ef. 1-1-02; AFS 5-2002, f. & cert. ef.
4-1-02; AFS 10-2002, f. & cert. ef. 7-1-02; AFS 22-2002, f. 12-31-02, cert.
ef. 1-1-03; SSP 33-2003, f. 12-31-03, cert. ef. 1-4-04; SSP 22-2004, f. & cert.
ef. 10-1-04; SSP 24-2004, f. 12-30-04, cert. ef. 1-1-05; SSP 19-2005, f. 12-30-05,
cert. ef. 1-1-06; SSP 5-2006(Temp), f. & cert. ef. 3-6-06 thru 8-31-06; SSP
10-2006, f. 6-30-06, cert. ef. 7-1-06; SSP 15-2006, f. 12-29-06, cert. ef. 1-1-07;
SSP 4-2007, f. 3-30-07, cert. ef. 4-1-07; SSP 14-2007, f. 12-31-07, cert. ef. 1-1-08;
SSP 26-2008, f. 12-31-08, cert. ef. 1-1-09; SSP 38-2009, f. 12-31-09, cert. ef.
1-1-10; SSP 35-2011, f. 12-27-11, cert. ef. 1-1-12; SSP 37-2012, f. 12-28-12, cert.
ef. 1-1-13; SSP 37-2013, f. 12-31-13, cert. ef. 1-1-14; SSP 4-2015, f. & cert.
ef. 1-1-15
461-160-0590
Assessment of Resources; Community Spouse Provision
For OSIP and OSIPM, this rule applies to an institutionalized spouse who began a continuous period of care on or after October 1, 1989:
(1) Assess a couple's combined countable resources at the beginning of each continuous period of care when requested by either spouse or by a representative acting on behalf of either spouse.
(2) Advise requesting parties of the verification needed to make the assessment. Verification of ownership interest and current value of resources must be provided. When verification is not provided within specified time frames, advise requesting parties that an assessment cannot be completed.
(3) Requesting parties have a right to appeal the determination of countable resources at the time of the assessment.
(4) If either spouse disagrees with the amount or the method of computation of the community spouse's allowances, they are entitled to a hearing within 30 days of the date of the request for the hearing.
Stat. Auth.: ORS 411.060, 411.070, 411.404 & 411.706

Stats. Implemented: ORS 183.415, 411.060, 411.070, 411.083, 411.404, 411.704 & 411.706

Hist.: AFS 80-1989, f. 12-21-89, cert. ef. 2-1-90
461-160-0600
Availability of Income; Couple with an Institutionalized Spouse
This rule applies to an OSIP or OSIPM institutionalized spouse who began a continuous period of care on or after October 1, 1989.
(1) Do not deem any of the community spouse's income available to the institutionalized spouse at any time during the institutionalized spouse's continuous period of care.
(2) Determine the ownership of income from property that belongs to the institutionalized or community spouse as follows, unless legal documents specifically provide otherwise:
(a) If the payment is made solely to the institutionalized spouse or the community spouse, the income is available only to that spouse.
(b) If the payment is made to both the institutionalized and the community spouse, one-half of the income is available to each.
(c) If the payment is made to one spouse and another person, or to both spouses and another person, the income available to each spouse is whatever their share of the income is. If the payment is made to both spouses and another person, and it is not clear what each spouse's share of the income is, each spouse's share will be one-half of the couple's portion of the payment.
(d) If the institutionalized spouse can prove that the ownership of income is other than provided above, allow that amount.
Stat. Auth.: ORS 411.060

Stats. Implemented: ORS 411.060

Hist.: AFS 80-1989, f. 12-21-89, cert. ef. 2-1-90; AFS 29-1994, f. 12-29-94, cert. ef. 1-1-95; SSP 16-2003, f. & cert. ef. 7-1-03
461-160-0610
Client Liability; OSIPM (except OSIPM-EPD)
(1) A client in the OSIPM (except OSIPM-EPD)
program who receives long-term care (see OAR 461-001-0000) services must, in order
to remain eligible, make the payment required by this rule, except as provided in
sections (2) to (6) of this rule. The client must apply his or her adjusted income
to the cost of the care or service. This amount is the client liability. If the
client's adjusted income exceeds the cost of care or service, the client must pay
the full cost of care but has no additional liability.
(2) A client who receives
SSI, or is deemed to receive SSI under section 1619(b) of the Social Security Act
(42 U.S.C. § 1382h(b)), is eligible for OSIPM program benefits without having
to make a payment.
(3) The IC service payment
of a client in the OSIPM-IC program is reduced by the amount of his or her liability.
(4) The following clients,
if they receive the services described in section (5) of this rule, are exempt from
payments required by this rule:
(a) A disabled adult child
under OAR 461-135-0830.
(b) A widow or widower under
OAR 461-135-0820.
(c) A Pickle amendment client
under OAR 461-135-0780.
(5) A client identified in
section (4) of this rule is exempt from payments required by this rule if the client
receives:
(a) Home and community-based
care (see OAR 461-001-0030); or
(b) Mental health services
and lives in a mental health residential treatment facility. For purposes of this
rule, only the following types of treatment centers qualify as a mental health residential
treatment facility:
(A) A mental health adult
foster home.
(B) A mental health residential
treatment home.
(C) A mental health residential
treatment facility.
(D) A mental health secure
residential treatment facility.
(6) In the initial month
of placement, a client may be exempt from payments required under this rule if the
Department determines that the client's income has been exhausted prior to placement.
If any income remains, the client must contribute to the cost of care or service.
(7) A client residing in
an acute care hospital is exempt from payments required by this rule while residing
in the acute care hospital. If a service benefit was received prior to admission
to the acute care hospital, payment must be made for that service.
Stat. Auth.: ORS 411.060, 411.070, 411.404,
411.706
Stats. Implemented: ORS 411.060,
411.070, 411.404, 411.706
Hist.: AFS 80-1989, f. 12-21-89,
cert. ef. 2-1-90; AFS 29-1994, f. 12-29-94, cert. ef. 1-1-95; 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 16-2003, f. & cert. ef. 7-1-03;
SSP 22-2004, f. & cert. ef. 10-1-04; SSP 8-2005(Temp), f. & cert. ef. 7-1-05
thru 10-1-05; SSP 9-2005(Temp), f. & cert. ef. 7-6-05 thru 10-1-05; SSP 14-2005,
f. 9-30-05, cert. ef. 10-1-05; SSP 19-2005, f. 12-30-05, cert. ef. 1-1-06; SSP 14-2006,
f. 9-29-06, cert. ef. 10-1-06; SSP 15-2006, f. 12-29-06, cert. ef. 1-1-07; SSP 4-2007,
f. 3-30-07, cert. ef. 4-1-07; SSP 7-2007, f. 6-29-07, cert. ef. 7-1-07; SSP 23-2008,
f. & cert. ef. 10-1-08; SSP 38-2009, f. 12-31-09, cert. ef. 1-1-10; 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
461-160-0620
Income Deductions and Client Liability;
Long-Term Care Services or Home and Community-Based Care; OSIPM
In the OSIPM program:
(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) Except as provided otherwise
in OAR 461-160-0610, the liability of the individual is determined according to
subsection (3)(i) of this rule.
(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-AD and OSIPM-OAA programs.
The deduction is $85 in the OSIPM-AB 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 $60 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. $1,992 is added to the amount over $598 that is
needed to pay monthly shelter expenses for the principal residence of the couple.
This sum or $2,980.50 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
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 $1,992. To determine the income allowance of each eligible dependent:
(i) The monthly income of
the eligible dependent is deducted from $1,992.
(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
TANF adjusted income standard 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. This includes the public and private health insurance premiums of the community
spouse and the individual's dependent.
(h) After taking all the
deductions allowed by this rule, the remaining balance is the adjusted income.
(i) The individual's liability
is determined as follows:
(A) For an individual receiving
home and community-based care (except an individual identified in OAR 461-160-0610(4)),
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
each month as a condition of being eligible for home and community-based care. In
OSIPM-IC, the liability is subtracted from the gross monthly benefit.
(B) For an individual who
resides in a nursing facility, a state psychiatric hospital, an Intermediate Care
Facility for the Mentally Retarded, or a mental health facility, there is a liability
as described at OAR 461-160-0610.
(4) The deduction used to
determine adjusted income for a GA and GAM client receiving long-term care services
or home and community-based care is as follows:
(a) One standard earned income
deduction of $65 is made from the earned income for an individual who is not blind;
or
(b) One standard earned income
deduction of $85 is made from the earned income for an individual who is blind.
Stat. Auth.: ORS 409.050, 411.060, 411.070,
411.706, 413.085, 414.065, 414.685
Stats. Implemented: ORS 409.010,
409.050, 411.060, 411.070, 411.706, 413.085, 414.065, 414.685
Hist.: AFS 80-1989, f. 12-21-89,
cert. ef. 2-1-90; AFS 16-1990, f. 6-29-90, cert. ef. 7-1-90; AFS 13-1991. f. &
cert. ef. 7-1-91; AFS 8-1992, f. & cert. ef. 4-1-92; AFS 17-1992, f. & cert.
ef. 7-1-92; AFS 28-1992, f. & cert. ef. 10-1-92; AFS 5-1993, f. & cert.
ef. 4-1-93; AFS 19-1993, f. & cert. ef. 10-1-93; AFS 6-1994, f. & cert.
ef. 4-1-94; AFS 29-1994, f. 12-29-94, cert. ef. 1-1-95; AFS 10-1995, f. 3-30-95,
cert. ef. 4-1-95; AFS 23-1995, f. 9-20-95, cert. ef. 10-1-95; AFS 15-1996, f. 4-29-96,
cert. ef. 5-1-96; AFS 5-1997, f. 4-30-97, cert. ef. 5-1-97; AFS 6-1998(Temp), f.
3-30-98, cert. ef. 4-1-98 thru 5-31-98; AFS 8-1998, f. 4-28-98, cert. ef. 5-1-98;
AFS 1-1999(Temp), f. & cert. ef. 2-1-99 thru 7-31-99; AFS 3-1999, f. 3-31-99,
cert. ef. 4-1-99; AFS 6-1999, f. & cert. ef. 4-22-99; AFS 3-2000, f. 1-31-00,
cert. ef. 2-1-00; AFS 10-2000, f. 3-31-00, cert. ef. 4-1-00; AFS 17-2000, f. 6-28-00,
cert. ef. 7-1-00; AFS 25-2000, f. 9-29-00, cert. ef. 10-1-00; AFS 6-2001, f. 3-30-01,
cert. ef. 4-1-01; AFS 11-2001, f. 6-29-01, cert. ef. 7-1-01; AFS 5-2002, f. &
cert. ef. 4-1-02; AFS 10-2002, f. & cert. ef. 7-1-02; AFS 22-2002, f. 12-31-02,
cert. ef. 1-1-03; SSP 16-2003, f. & cert. ef. 7-1-03; SSP 23-2003, f. &
cert. ef. 10-1-03; SSP 33-2003, f. 12-31-03, cert. ef. 1-4-04; SSP 17-2004, f. &
cert. ef. 7-1-04; SSP 24-2004, f. 12-30-04, cert. ef. 1-1-05; SSP 7-2005, f. &
cert. ef. 7-1-05; SSP 8-2005(Temp), f. & cert. ef. 7-1-05 thru 10-1-05; SSP
9-2005(Temp), f. & cert. ef. 7-6-05 thru 10-1-05; SSP 14-2005, f. 9-30-05, cert.
ef. 10-1-05; SSP 19-2005, f. 12-30-05, cert. ef. 1-1-06; SSP 10-2006, f. 6-30-06,
cert. ef. 7-1-06; SSP 14-2006, f. 9-29-06, cert. ef. 10-1-06; SSP 15-2006, f. 12-29-06,
cert. ef. 1-1-07; SSP 4-2007, f. 3-30-07, cert. ef. 4-1-07; SSP 7-2007, f. 6-29-07,
cert. ef. 7-1-07; SSP 14-2007, f. 12-31-07, cert. ef. 1-1-08; SSP 17-2008, f. &
cert. ef. 7-1-08; SSP 26-2008, f. 12-31-08, cert. ef. 1-1-09; SSP 13-2009, f. &
cert. ef. 7-1-09; SSP 18-2011(Temp), f. & cert. ef. 7-1-11 thru 12-28-11; SSP
25-2011, f. 9-30-11, cert. ef. 10-1-11; SSP 35-2011, f. 12-27-11, cert. ef. 1-1-12;
SSP 23-2012(Temp), f. 6-29-12, cert. ef. 7-1-12 thu 12-28-12; SSP 30-2012, f. 9-28-12,
cert. ef. 10-1-12; SSP 37-2012, f. 12-28-12, cert. ef. 1-1-13; SSP 16-2013(Temp),
f. & cert. ef. 7-1-13 thru 12-28-13; SSP 25-2013, f. & cert. ef. 10-1-13;
SSP 37-2013, f. 12-31-13, cert. ef. 1-1-14; SSP 3-2014, f. 1-31-14, cert. ef. 2-1-14;
SSP 15-2014, f. & cert. ef. 7-1-14; SSP 17-2014(Temp), f. & cert. ef. 7-1-14
thru 12-28-14; SSP 24-2014, f. & cert. ef. 10-1-14; SSP 4-2015, f. & cert.
ef. 1-1-15; SSP 21-2015, f. & cert. ef. 7-1-15
461-160-0630
Deduction for Maintaining a Home;
Long-Term Care Client
In the OSIP and OSIPM programs, a single
client in long term care is eligible for a home maintenance deduction for up to
six months if:
(1) A physician has documented
that the client is likely to return home within six months;
(2) The amount of the deduction
is reasonable in relation to the applicable OSIP shelter standard; and
(3) The Department determines
that maintaining the home is an essential part of a plan for the client's relocation
to a less restrictive living situation.
Stat. Auth.: ORS 411.060, 411.404
Stats. Implemented: ORS 411.060,
411.404
Hist.: AFS 80-1989, f. 12-21-89,
cert. ef. 2-1-90; AFS 29-1994, f. 12-29-94, cert. ef. 1-1-95; AFS 10-2002, f. &
cert. ef. 7-1-02; SSP 30-2013(Temp), f. & cert. ef. 10-1-13 thru 3-30-14; SSP
38-2013, f. 12-31-13, cert. ef. 1-1-14
461-160-0780
Determining Adjusted Income; OSIP-EPD and OSIPM-EPD
Adjusted income for OSIP-EPD and OSIPM-EPD
is determined as follows:
(1) All unearned income is excluded.
(2) From gross earned income,
one standard income deduction of $20 is deducted.
(3) One standard earned income
deduction of $65, or $85 for individuals whose disability is based on blindness,
is deducted.
(4) The remainder is divided
by two.
(5) Any costs allowed as
employment and independence expenses, Impairment Related Work Expenses, or Blind
Work Expenses as defined in OAR 461-001-0035 are deducted.
(6) The remainder is adjusted
income.
Stat. Auth.: ORS 409.050, 411.060, 411.404
Stats. Implemented: ORS 409.010,
411.060, 411.070, 411.404
Hist.: 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 17-2000, f. 6-28-00, cert. ef. 7-1-00; SSP 15-2006, f. 12-29-06, cert. ef. 1-1-07;
SSP 37-2013, f. 12-31-13, cert. ef. 1-1-14
461-160-0800
Determining
Participant Fee; OSIP-EPD, OSIPM-EPD (Including In-Home Services)
(1) Individuals
who receive OSIP-EPD and OSIPM-EPD program benefits will have a participant fee
(see section (2) of this rule) but do not have a client liability as discussed in
OAR 461-160-0620.
(2) In
the OSIP-EPD and OSIPM-EPD programs, the participant fee is calculated using the
Federal Poverty Level (FPL) (see OAR 461-155-0290) and the individual's total countable
(see OAR 461-001-0000) income as follows:
(a) For
clients with countable income less than 75 percent of the FPL, the participant fee
is $0.
(b) For
clients with countable income equal to or greater than 75 percent but less than
100 percent of the FPL, the participant fee is $50 per month.
(c) For
clients with countable income equal to or greater than 100 percent but less than
250 percent of the FPL, the participant fee is $100 per month.
(d) For
clients with countable income equal to or greater than 250 percent of the FPL, the
participant fee is $150 per month.
(3) The
participant fee under section (2) of this rule must be paid each month as a condition
of eligibility for as long as the individual is an OSIP-EPD or OSIPM-EPD client.
(4) OSIP-EPD
and OSIPM-EPD clients in a licensed community-based care facility must pay room
and board costs in addition to their participant fees.
(5) The
local office may waive unpaid participant fees if the individual provides verification
(OAR 461-115-0610) of significant economic difficulty, such as, but not limited
to, homelessness, divorce, domestic violence (see OAR 461-001-0000), or illness.
Stat. Auth.:
ORS 411.060, 411.070, 414.042

Stats.
Implemented: ORS 411.060, 411.070, 414.042

Hist.:
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 17-2000, f. 6-28-00, cert. ef. 7-1-00; SSP 6-2008(Temp), f.
2-29-08, cert. ef. 3-1-08 thru 8-28-08; SSP 17-2008, f. & cert. ef. 7-1-08;
SSP 17-2011, f. & cert. ef. 7-1-11
461-160-0855
Excluded Resources for Payments Received Under a Qualified Partnership Policy; OSIPM
In the OSIPM program:
(1) When a client in a non-standard living arrangement (see OAR 461-001-0000) applies for medical benefits, the Department excludes as a resource an amount equal to the insurance payments received under a Qualified Partnership Policy (see OAR 461-001-0000) as of the initial month (see OAR 461-001-0000) of eligibility, unless the Qualified Partnership Policy was purchased in a state that has elected not to participate in reciprocity.
(2) The exclusion in section (1) of this rule:
(a) Does not apply when home equity exceeds the limit in OAR 461-145-0220(2)(a); and
(b) Applies to all other resources (not covered by subsection (a) of this section), notwithstanding other rules in this chapter of rules that designate the resources as countable.
(3) For the amount of resources excluded under this rule, the Department will not establish a claim against the deceased person's estate in accordance with OAR 461-135-0835.
Stat. Auth.: ORS 411.060, 411.070, 411.083, 411.404, 411.704, 411.706, 411.708, 414.025

Stats Implemented: ORS 411.060, 411.070, 411.083, 411.404, 411.704, 411.706, 411.708, 414.025

Hist.: SSP 14-2007, f. 12-31-07, cert. ef. 1-1-08; SSP 32-2010, f. & cert. ef. 10-1-10


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