Current through Register Vol. 63, No. 9, September 1, 2024
(1) In the following circumstances, personal
incidentals and room and board allowances may be paid for an individual to
reside in a community-based care facility (see OAR
461-155-0630(1))
to avoid placement in a nursing facility or leave a nursing facility or an
acute care hospital, when an individual meets the requirements of one of the
following subsections:
(a) Is determined to be
eligible based on a disability determination made by the Department (see OAR
461-125-0370).
(A) To receive this payment, the individual
must pursue Supplemental Security Income (SSI) by making application with the
Social Security Administration (SSA) and appealing denials until SSA makes a
final administrative decision. If SSI is denied at the final SSA administrative
level, the individual is no longer eligible for this payment.
(B) The payment is the difference between the
countable (see OAR 461-001-0000) income of the
individual and the OSIPM program adjusted income standard (see OAR
461-155-0250).
(b) Is leaving a nursing facility and limited
to a maximum SSI payment of $30 or to a maximum Veterans benefit payment of
$90. The payment is the difference between the countable income of the
individual and the OSIPM program adjusted income standard (see OAR
461-155-0250).
(c) Is a qualified non-citizen under OAR
461-120-0125 who is not eligible
for SSI due to not meeting the requirements to become a naturalized citizen
within the SSI time limit.
(A) The individual
must pursue naturalization.
(B) The
payment is the difference between the countable income of the individual and
the OSIPM adjusted income standard (see OAR
461-155-0250).
(d) Does not have sufficient income to divert
to the
community spouse (see OAR
461-001-0030) due to the
difference between the personal needs allowance related to a nursing facility
placement and the personal needs allowance and room and board related to a
community-based care facility placement. The allowance is
issued only when the individual or
community spouse requests
or chooses a nursing facility placement rather than a
community-based
care facility placement because the
community spouse
needs the resulting higher diversion amount to meet his or her monthly
expenses.
(A) For all individuals, the
allowance is the difference between the amount of the individual's income that
would be available to divert to the community spouse under a
nursing facility placement and the amount of the individual's income available
under the community-based care facility placement, using the
liability calculation as outlined in OAR
461-160-0620.
(B) For an individual under a
community-based care facility placement whose income is less
than the adjusted OSIPM program standard, the allowance is the amount
calculated under paragraph (A) of this subsection plus the difference between
the OSIPM program adjusted income standard and the individual's
countable income.
(2) Room and board allowance (see OAR
461-155-0270), without personal
incidentals, may be paid for an individual to reside in a
community-based care facility to avoid placement in a nursing
facility, when an individual is leaving a public institution
(see OAR 461-135-0950) and the
individual's SSI is suspended, subject to the following provisions:
(a) The individual's SSI must have been
suspended due to placement in a public institution.
(b) The individual must pursue reinstatement
of SSI, and verification must be provided to the Department.
(c) The payment is the difference between the
countable income of the individual and the OSIPM Room and Board Standard (see
OAR 461-155-0270).
(d) If SSI is reinstated or reinstatement of
SSI is denied, the individual is no longer eligible for this
allowance.
(3) The
payment amount is prorated in the first month for an individual who moves to a
community-based care facility on any day other than the first
day of the month.
Statutory/Other Authority: ORS
411.060,
411.070,
411.704 &
411.706
Statutes/Other Implemented: ORS
411.060,
411.070,
411.704 &
411.706
