Page 545
545 (07/2026) Chapter 2:Eligibility • Section 10: Long-Term Care (LTC) services • The individual must meet all non-financial eligibility requirements for OSIPM. • The individual is considered in their own household and filing group. • The financial group consists of only the individual applying for benefits. However, the spousal impoverishment guidelines apply, so a resource assessment must be completed. AVS must also be run. • The individual must have countable income at or below 300 percent of the full SSI standard or have established a qualifying trust, and • The individual must require a continuous period of care, which means the individual must be expected to stay in the hospital, nursing facility or another service setting for at least 30 days or until death.
Evidence of the expectation is required, but do not wait until the 31st day to determine if they met the requirements.
The 30-day continuous period of care could include multiple settings. Note: Individuals who are eligible for MAGI or OSIPM under a standard living arrangement do not need to be evaluated for ACS. This rule is here for those who would otherwise be over income or resource limits. It establishes that these individuals are treated as if they were receiving or applying for services. If an individual needs a long-term care payment (not post-hospital extended care) and does not have Medicare, determine eligibility under the long-term care or home and community-based care rule. Note: An individual in an acute care hospital may accumulate resources. If they are above the resource limit, they will need to spend-down or become ineligible. For an individual already receiving OSIPM when they are admitted to an acute care hospital, benefits can continue as long as they continue to meet program requirements. Remember that after 30 days, individuals are no longer part of their original household group, if it contained other individuals, and eligibility is evaluated under the acute care setting rule. Other resources OSIPM - Acute Care Settings (ACS) *includes screenshots: Describes how to evaluate medical benefits for Oregonians who have a continuous period of care in an acute care setting like hospital or nursing facility. Independent Choices (IC) program To be eligible for OSIP/OSIPM-IC a person must: • Meet Title XIX waiver criteria for in-home services contained in 411-030-0040, and • Meet eligibility criteria for the Independent Choices program in 411-030-0100. Oregon Project Independence (OPI) OPI is a program designed to help people stay in their homes whose care needs meet at least one of the service priority levels (SPL) 1-18 of OAR 411-015-0010 and are not eligible for Medicaid long-term care services. All personal care and homecare services are provided by a state-registered homecare worker or in-home care agency. OPI recipients may be required to pay a fee towards their cost of services based on a sliding scale.