OAR 411-450-0030: Eligibility for Community Living Supports

(1) An individual may not be denied community living supports or otherwise discriminated against on the basis of race, color, religion, sex, gender identity, sexual orientation, national origin, marital status, age, disability, source of income, duration of Oregon residence, or other protected classes under federal and Oregon Civil Rights laws. (2) To be eligible for community living supports, an individual must meet the following requirements: (a) Be an Oregon resident who meets the residency requirements in OAR 461-120-0010. (b) Be determined eligible for developmental disabilities services by the Community Developmental Disabilities Program of the county of origin according to OAR 411-320-0080, except for those enrolled in the following: (A) A child enrolled in the Medically Involved Children's Program must meet the eligibility requirements in OAR 411-300-0120(7). (B) A child enrolled in the Medically Fragile Children's Program must meet the eligibility requirements in OAR 411-300-0120(5). (C) A child enrolled in the Children's Extraordinary Needs Program must meet the eligibility requirements in OAR 411-440-0030. (c) Choose to use a case management entity for assistance with the design and management of developmental disabilities services. (d) Be receiving a Medicaid Title XIX benefit package through Oregon Supplemental Income Program-Medical (OSIPM) or Health Systems Division(HSD) medical programs or a benefit package through Healthier Oregon. (A) An adult is eligible for community living supports if the adult had been receiving community living supports as a child up to their 18th birthday and has not become ineligible due to section (2)(d)(B) of this rule. (B) Eligibility for community living supports based on section (2)(d)(A) of this rule ends if: (i) The individual does not apply for a disability determination and Medicaid within 10 business days of their 18th birthday; (ii) The Social Security Administration or the Department's Presumptive Medicaid Disability Determination Team finds the individual does not have a qualifying disability; or (iii) The individual is determined by the state of Oregon to be ineligible for a Medicaid Title XIX benefit package through OSIPM or HSD medical programs or a benefit package through Healthier Oregon. (C) Individuals receiving Medicaid Title XIX through HSD medical programs for services in a nonstandard living arrangement, as defined in OAR 461-001-0000, are subject to the requirements in the same manner as if they were requesting these services under OSIPM, including the rules regarding: (i) The transfer of assets as set forth in OAR 461-140-0210 through 461-140-0300. (ii) The equity value of a home which exceeds the limits as set forth in OAR 461-145-0220. (e) Be determined to meet the Level of Care as defined in OAR 411-317-0000. (f) Individuals with excess income must contribute to the cost of services in accordance with OAR 461-160-0610 and OAR 461-160-0620. (g) Participate in an Oregon Needs Assessment and provide information necessary to complete the Oregon Needs Assessment prior to receiving community living supports, annually, and as required by the Department. (A) Failure to participate in the Oregon Needs Assessment or to provide information necessary to complete the Oregon Needs Assessment within the required time frame results in the denial or termination of service eligibility. In the event service eligibility is denied or terminated, a written Notification of Planned Action must be provided as described in OAR 411-318-0020. (B) The Department may allow additional time if circumstances beyond the control of the individual prevents timely participation in the Oregon Needs Assessment or timely submission of information necessary to complete the Oregon Needs Assessment.