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1156 Chapter 7:Worker guides • Section 7: OSIPM worker guides (07/2026) Remember – part of the spend down will be met by additional QPP payments Bernie receives while spending down. The individual is entitled to a resource exclusion for the total QPP payments received at the time of the initial month of eligibility. The eligibility worker should add a case note with the total amount of resources excluded due to the receipt of QPP payments, when the case is approved. The worker also notifies the Estate Administration by the “Remarks” section of the MSC 0647. If the individual has accessed all of the LTC payments prior to applying for Medicaid, then the individual is eligible for a resource exclusion for the total value of the policy. Example 5: Milo, who is married to Gertrude, is applying for services. Milo exhausted a $120,000 QPP prior to applying for Medicaid and the couple have countable resources of $280,000. When doing the resource assessment, the eligibility worker determines that ½ of the resources ($140,000) exceeds the maximum, so Gertrude’s community spouse resource allowance (CSRA) is $109,560. The eligibility worker determines that $280,000 countable resources minus ($120,000 QPP exclusion + $2000 individual resources + $109,560 CSRA) = $48,440 that the couple has now that exceeds the resource limit. After the couple has spent down this excess, Milo will be eligible for Medicaid with resources of $122,000 for Milo and $109,560 for Gertrude = $231,560 total. The eligibility worker adds case note that $120,000 in resources were excluded due to the receipt of QPP payments, when the case is approved. The worker also notifies the Estate Administration by the “Remarks” section of the MSC 0647. Example 6: Howard has exhausteda $120,000 QPP prior to applying for Medicaid and now has countable resources of $121,500. The worker excludes $120,000 and finds Howard eligible because the remaining countable resources are $1500. The eligibility worker adds a case note that $120,000 in resources were excluded due to the receipt of QPP payments, when the case is approved. The worker also notifies the Estate Administration by the “Remarks” section of the MSC 0647. The individual’s QPP amount can change, if the Medicaid case is approved with a QPP exclusion, the case closes (for 30 days or more) and the individual receives more QPP payments, and the case is subsequently approved again. Example 7: Wanda has a QPP and receives $70,000 in payments before being determined eligible for Medicaid. The eligibility worker adds a case note that Wanda is eligible for a QPP exclusion of $70,000 and sends a MSC 0647 to Estate Administration. Wanda continues to receive QPP payments while receiving Medicaid, and those are reimbursed to ODHS|OHA. Wanda then receives a $120,000 inheritance and the case closes for 6 months. When Wanda again becomes eligible for Medicaid, the eligibility worker determines that the cumulative QPP payments are now $150,000. The worker adds a case note that Wanda is eligible for a revised QPP exclusion of $150,000 and sends a MSC 0647 (indicating the amount of the QPP protection in the “Remarks” section) to Estate Administration. Note: Be sure to verify the value of resources excluded due to QPP payments at redetermination. If the resources have grown to exceed the resource limit, give notice to close the case. The individual will need to spend the excess or reimburse ODHS for past assistance to avoid case closure. If the excluded resources have decreased in value due to no action on the individual’s part (such as losing value due to the economy), additional assets may be excluded up to the entire QPP amount. If the excluded resources