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537 (07/2026) Chapter 2:Eligibility • Section 10: Long-Term Care (LTC) services

Š Disabled widow or widower

Š Pickle Amendment individuals

Š An individual residing in an acute care hospital is exempt from payments required by this rule while in the hospital. If a service benefit was received prior to admission to the acute care hospital, payment must be made for that service. Note: The Independent Choices (IC) service payment of individuals is reduced by the amount of their liability. Calculating the liability Allow deductions in the order below for individuals who are OSIPM eligible and receiving LTC services. Note: SSI recipients do not have a liability; however, when an SSI recipient enters a nursing facility, workers should complete the SDS 0538A and send it to the Social Security Administration. • Deduct one standard earned income deduction of $65. • Allow deductions under the plan for self-support. • Deduct one of the following need standards:

Š A $81.28 personal needs allowance for individuals in a nursing facility.

Š A $90 personal needs allowance for individuals in a nursing facility who are eligible for VA Aid & Attendance benefits (UME). The $90 allowance is only allowed when the VA benefit has been reduced to $90.

Š For an individual who receives community-based care (AFH, ALF, RCF, etc.), the OSIPM standard. • Deduct the community spouse monthly income allowance from the income of the institutionalized spouse to the extent that the income is made available to or for the benefit of the community spouse, using the following calculation.

Š Step 1 — Determine the maintenance needs allowance. $2,705.00 is added to the amount over $811.50 that is needed to pay monthly shelter expenses for the principal residence of the couple. This sum or $4,066.50 whichever is less, is the maintenance needs allowance. » For the purpose of this calculation, shelter expenses are the rent or home mortgage payment (principal and interest), taxes (do not allow a deduction for deferred taxes), insurance, required maintenance charges for a condominium or cooperative. Also allow the full standard utility allowance (FUA) for the SNAP program if any utilities are paid (including only telephone).

Š Step 2 — Compare maintenance needs allowance with the countable income of the community spouse. The countable income of the community spouse is subtracted from the maintenance needs allowance determined in step 1. The difference is the income allowance unless the allowance described in step 3 is greater.

Š Step 3 — If a spousal support order or exceptional circumstances resulting in significant financial distress require a greater income allowance than that calculated in step 2, the greater amount is the allowance. Requests to raise the monthly maintenance needs allowance must be submitted to central office; they cannot be approved at the branch level. Email requests to APD. MedicaidPolicy@odhsoha.oregon.gov.