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217 (07/2026) Chapter 2:Eligibility • Section 5: Financial eligibility At initial certification – 200% FPL; During the certification and at recertification – the income limit is higher (250% of FPL or 85% SMI, whichever is higher – see DHS 5530); • Copay must also be less than the amount ERDC will pay; otherwise, the applicant is ineligible. Click here for examples: Categorical eligibility. Oregon Administrative Rule(s) 461-135-0505 — Categorical Eligibility for SNAP 414-175-0025 — Categorical Eligibility for ERDC Special eligibility for Medicaid individuals Assumed eligibility Assumed eligible individuals are assumed to meet the requirements for a program. MSP People who receive Part A of Medicare and SSI are assumed to meet the financial and citizen/non-citizen requirements for QMB; there is no assumed eligibility for SMB or SMF. This means that the person will receive QMB for as long as they meet all the non-financial requirements. They still have to meet residency and pursuit of health care coverage (except Medicare) and cash medical support requirements as described in “Pursuit of assets.” OSIPM The following groups of individuals are assumed to meet the financial and citizen/non-citizen requirements for. This means that the person will receive OSIPM for as long as they meet the medical assignment and medical support pursuit requirements in OARs 461-120-0315 and 461-120-0345 and the residency requirements in OAR 461-120- 0010. These groups include: • Recipients of SSI benefits; . • People deemed eligible for SSI under Sections 1619(b) of the Social Security Act that covers individuals whose impairment has not changed, but who have become gainfully employed and have continuing need for Medicaid Note: Individuals assumed eligible for OSIPM are still subject to the disqualifying transfer of assets provisions in OAR 461-140-0210 to 461-140-0300, the home equity limits in OAR 461-145-0220, and the community spouse resource allowance provisions in OAR 461-160-0580 when applying for or receiving long-term care services Note: If an existing SSI service recipient receives or obtains resources that place them over the resource limit, complete a 538A and send to SSA, but do not close OSIPM or services until or unless SSA terminates SSI. Note: If an assumed eligible individual in a standard living arrangement reports a transfer, provide them with a copy of the SDS 0543.