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543 (07/2026) Chapter 2:Eligibility • Section 10: Long-Term Care (LTC) services formulary: These are costs (coded as MDC in legacy) associated with off-formulary drugs that may only be used as a cost if the individual has filed an exception with their Medicare Part D plan and the exception has been denied. The plan’s denial notice will be used as verification for deducting the costs of non-formulary drugs. Legacy actions needed when adding/updating costs in ONE When an individual provides verification of new or updated medical costs, the liability will be updated once the cost is entered into ONE and notice will be sent informing them or the new payment amount. However, action must be taken to update the payment systems in legacy. Eligibility workers must coordinate with case managers to complete these actions. If the individual has not paid the liability for the month, the case manager must adjust the liability through the SFMU legacy screen using the OM (other medical) adjustment reason code. If the individual has paid the liability, the same adjustment is made in SFMU, but the individual will receive a refund check for the amount the liability was reduced. Click here for examples: Medical costs. Oregon Administrative Rule(s) 461-160-0030 — Overview of Costs 461-160-0055 — Medical Costs That Are Deductible; OSIP, OSIPM, and SNAP 461-160-0620 — Income Deductions and Patient Liability; Long-Term Care Services or Home and Community- Based Care; OSIPM 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. Non-financial eligibility There are some additional non-financial eligibility requirements concerning individuals applying for or receiving services. Service priority level (SPL) SPL is a term specific to APD LTC services that means the individual needs help to meet their daily needs. To qualify, the assistance must be with things like moving around inside their home, using the restroom, eating, getting up and down from furniture or in and out of bed, and/or help understanding how to meet their daily health and safety needs. Needing assistance with housekeeping, cooking meals, laundry and/or shopping does not impact SPL eligibility. Long-Term Services and Supports (LTSS) screeners will gather most of the information about the individual’s care needs, but the conversation frequently starts during an eligibility interview for other benefits. Once the Oregonian has spoken to the LTSS screening team, a case manager will meet with the individual where they live to assess their needs.