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573 (07/2026) Chapter 2:Eligibility • Section 11: Medical Related Payments (MRP)
For all individuals, the allowance is the difference between the amount of the individual’s income that would be available to divert to the community spouse under a nursing facility placement and the amount of the individual’s income available under the CBC facility placement, using the liability calculation.
For an individual whose income is less than the adjusted OSIPM program standard, the allowance is the amount calculated under the paragraph above plus the difference between the OSIPM program adjusted income standard and the individual’s countable income. Room and board only, without personal incidentals, may be paid for an individual to reside in a CBC facility to avoid placement in a nursing facility when an individual is leaving a public institution and the individual’s SSI is suspended, subject to the following provisions. The payment amount is prorated in the first month for an individual who moves to a CBC facility on any day other than the first day of the month. • The individual’s SSI was suspended due to placement in a public institution. • The individual must pursue SSI and verification must be provided to ODHS|OHA. • The payment is the difference between the individual’s countable income and the OSIPM Room and Board Standard. • If SSI is reinstated or reinstatement is denied, the individual is no longer eligible for this payment. When approving one-time payments, send a 541 with the amount of the payment in the initial month field and $0 in the ongoing months field. The notice should use the ONE case number. If there is not a ONE case number generated and a manual notice is still needed, utilize the application number. Then add any needed details in the comments section of the form. Please see the Issuing Special Needs Payments for Personal Incidentals and/or Room & Board WG for special notice requirements when issuing this special need. Oregon Administrative Rule(s) 461-155-0700 — Special Need; Personal Incidentals and Room and Board Allowances; OSIPM 461-155-0630 — Special Need; Community Based Care; OSIPM 461-125-0370 — Disability as the Basis of Need 461-120-0125 — Non-citizen Status Requirements 461-160-0620 — Income Deductions and Patient Liability; Long-Term Care Services or Home and Community- Based Care; OSIPM 461-135-0950 — Eligibility for Residents of Public Institutions 461-155-0270 — Room and Board Standard; OSIPM Diversion services ODHS|OHA may authorize one-time payments for expenses that ODHS|OHA has determined are necessary to divert OSIPM individuals who might otherwise be served in nursing facilities to community-based care (CBC). Payments are allowed for individuals who meet SPL 1 through 13 under 411-015-0015(1)(a). Payments will be authorized at the lowest possible cost. To be eligible for payment, individuals may not be eligible for the item through Medicare, Medicaid or any other medical coverage.