Statutes, codes, and regulations
Oregon Administrative Code
Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES
Division 14 - OREGON PROJECT INDEPENDENCE - MEDICAID (OPI-M) ELIGIBILITY
Section 411-014-0025 - Financial Eligibility for OPI-M

Or. Admin. Code § 411-014-0025

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Current through Register Vol. 63, No. 12, December 1, 2024
Section 411-014-0025 - Financial Eligibility for OPI-M
(1) The income and resource methodology for OSIPM outlined in OAR chapter 461 is used to determine financial eligibility for the OPI-M except as follows:
(a) In OPI-M an individual must have adjusted income (see OAR 461-001-0000) that is equal to or less than 400 percent of the federal poverty level for a family of one and may not be exceeded through qualifying trusts as specified in OAR 461-145-0540(9)(c).
(b) For an individual, the resource limit is calculated using the basic statutory daily nursing facility rate as described in OAR 411-070-0075(1) multiplied by 30.4 (average days per month) multiplied by six (6) months.
(c) At initial eligibility, the resources of the spouse (see OAR 461-001-0000) are considered and the provisions of OAR 461-160-0580(2)(f)(A) apply, except that the individual's resource limit is calculated in accordance with subsection (b) of this section.
(d) Individuals are subject to the rules regarding both of the following:
(A) The transfer of assets as set forth in OAR 461-140-0210 to 461-140-0300 except in OAR 461-140-0250 (2)(a)(A)(ii) the resource limit is the current OPI-M resource limit in OAR 411-014-0025(1)(b), not the OSIPM resource limit.
(B) The home equity value limits as set forth in OAR 461-145-0220.
(2) No payments or benefits paid under OPI-M shall be subject to the estate recovery program, including, without limitation, under OARs 461-135-0835, 461-135-0837, and 461-135-0845. Trustees of Medicaid-qualifying trusts (OARs 461-145-0540(10)(a), 461-145-0540(10)(c), or 461-145-0540(11)) need not repay these benefits under those trusts' required payback clauses. Notwithstanding the exclusion of OPI-M services from estate recovery, an individual must still comply with OAR 461-145-0022 Annuities: OSIPM.
(3) OPI-M recipients are not subject to a liability as described in OAR 461-160-0620.
(4) Periodic redeterminations of eligibility required in OAR 461-115-0430 are required every 24 months for people receiving OPI-M services.
(5) Notwithstanding OAR 411-014-0025(4) if one of the following circumstances occur during an individual's period of continuous OPI-M eligibility, OPI-M eligibility may be redetermined or terminated:
(a) The individual becomes pregnant or otherwise eligible for Medicaid or CHIP;
(b) The individual is no longer an Oregon resident;
(c) The individual requests termination of eligibility;
(d) The individual dies; or
(e) The agency determines that eligibility was erroneously granted at the most recent determination, redetermination, or renewal of eligibility because of agency error or fraud, abuse, or perjury attributed to the individual.

Or. Admin. Code § 411-014-0025

APD 23-2024, temporary adopt filed 05/20/2024, effective 5/31/2024 through 11/26/2024; APD 65-2024, adopt filed 11/20/2024, effective 11/22/2024

Statutory/Other Authority: ORS 409.050, 410.060, 410.070, 411.070, 411.404, 411.816, 412.049, 413.085 & 414.685

Statutes/Other Implemented: ORS 409.010, 410.060, 410.070, 411.070, 411.404, 411.816, 412.049, 413.085 & 414.685