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33 Chapter 1: Introduction to the Oregon Programs Eligibility Notebook • Section 1: Intent and overview of programs (07/2026) • Specified Low-income Medicare Beneficiary – SMB is a Medicare Part A recipient who has income more than 100% but less than 120% of the FPL. Coverage is limited to payment of their Medicare Part B premium. • Qualified Individual – SMF is a Medicare Part A recipient who has income from 120% to 135% of the FPL. Coverage is limited to payment of their Medicare Part B premium. There is another group, the Disabled Workers (DWs), who can have income up to 200% of the FPL. However, there aren’t any DWs in Oregon currently and there won’t be as long as Employed Persons with Disabilities (EPD) exists as a program. QMB-DW pays for the Medicare Part A premium only. Oregon Supplemental Income Program Medical (OSIPM) The Oregon Supplemental Income Program is a state and federally funded program that offers cash and full OHP medical assistance to low income aged and disabled individuals who qualify by meeting various financial and nonfinancial eligibility prerequisites. The Oregon Supplemental Income Program Medical (OSIPM) is provided to several groups of individuals: • Those assumed eligible for Medicaid due to receiving Supplemental Security Income (SSI) or being eligible for SSI through 1619(b) status as provided for under Section XVI of the Social Security Act. • Those with protected eligibility as a Disabled Adult Child or through the Pickle Amendment. • Those with income below the SSI standard. • Those who receive Behavioral Health services and have income below 150% of the federal poverty level. • Those who receive Long-Term Care (LTC) services through Aging and People with Disabilities (APD) or through the Office of Developmental Disabilities Services (ODDS) Intellectual/Developmental Disability (I/DD) services program in a home or community-based setting, nursing facility or state institution and have income below 300% of the SSI standard. • Working individuals with a disability who meet the requirements of the Employed Persons with Disabilities (EPD) program, such as income below 250% of the federal poverty level. • Effective July 1, 2023; those who meet all financial and non-financial eligibility requirements, except for citizen and non-citizen status requirements, are eligible for the Healthier Oregon program. Note: Between July 1, 2022-June 30, 2023, only individuals between the ages of 19-25 or 55 and older were eligible for Healthier Oregon. As of July 1, 2023, there is no age requirement for the Healthier Oregon program. OSIPM eligible individuals can receive cash payments (OSIP) called “special needs payments” if the individual meets the requirements of the rules. The individual may receive a one-time special need payment for a home repair or a monthly, ongoing special need payment for a laundry allowance, for example. To be eligible for OSIP, individuals must first be eligible for OSIPM. This program is the basis under which Medicaid is granted under the Old Age Assistance, Aid to the Disabled and Aid to the Blind Programs whereby the individual receives medical assistance through a managed care provider. Depending on the individual’s living arrangement, case management services are provided either by ODHS|OHA, Area Agencies on Aging (AAA), or county behavioral health or developmental disabilities programs. Eligible OSIPM individuals can be qualified for Medicare Savings Programs while receiving cash or medical benefits.