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539 (07/2026) Chapter 2:Eligibility • Section 10: Long-Term Care (LTC) services Other resources Medical Expenses: Medical expenses are allowable deductions for SNAP and Medical Programs. QRG covers the policy for medical expenses, screen steps, and verification requirements. Medicaid Service Liability Calculation: Describes how to calculate Medicaid Service Liability, who is subject to Service Liability, and how to work with Service Liability in ONE and MMIS. Patient Liability Manual Update *includes screenshots: Describes the Patient Liability Manual Update screen and its purpose. Describes the data entry needed to determine the Community Spousal Income Amount (CSIA). Community Based Care System and ONE: Describes using Community Based Care system to authorize and pay for residential long-term care services. Community Spouse Income Allowance (CSIA) This section explains how to determine what portion of the CSIA (formerly LDS) should be allowed, so that the amount is correct under the rule and to the individual’s and community spouse’s best advantage. Individuals in a nonstandard living arrangement are allowed a deduction for the income allowance (support) of the community spouse, to the extent that the support is made available to the spouse. We commonly refer to this support as the “LDS,” taken from the legacy code meaning “less diverted to spouse.” However, it is called the Community Spouse Income Allowance (CSIA) in ONE. The basic calculation for the CSIA involves starting with the need standard given in the rule (currently $2,705) and adding shelter costs in excess of the shelter standard in the same rule (currently $811.50). This sum or $3,853.50 (maximum in the rule), whichever is less, is the maintenance needs allowance. The countable income of the community spouse is subtracted from the maintenance needs allowance. The result is the amount of CSIA (as long as it does not exceed the maximum in the rule that the spouse is entitled to get from the individual if it is made available). The CSIA is usually calculated on the middle section of the Liability Worksheet (SDS 0450). In most cases, allowing the full CSIA amount is of the most benefit to the couple. However, sometimes it is more beneficial if none or only part of the CSIA is allowed. Any time the Oregonian is paying a different amount than the system-calculated CSIA (previously referred to as LDS), the worker needs to enter the actual amount into the “Manual CSIA” section on the Patient Liability Manual Update screen in ONE and rerun eligibility. Click here for examples: Deciding to what extent to allow the CSIA. Other resources Patient Liability Manual Update *includes screenshots: Describes the Patient Liability Manual Update screen and its purpose. Describes the data entry needed to determine the Community Spousal Income Amount (CSIA). Medical costs Costs are considered incurred when they are billed by the provider. Determine the amounts of the medical