OAR 461-160-0800: Determining Participant Fee; OSIP-EPD, OSIPM-EPD (Including In-Home Services)

(1) Individuals who receive OSIP-EPD and OSIPM-EPD program benefits will have a participant fee (see OAR 461-001-0035). (a) For individuals in a standard living arrangement (see OAR 461-001-0000), the participant fee is the amount calculated under section (2) of this rule. (b) For individuals in a nonstandard living arrangement (see OAR 461-001-0000), the participant fee is the amount calculated under section (2) of this rule or the patient liability as discussed in OAR 461-160-0620, whichever is less. (2) The participant fee is calculated using the Federal Poverty Level (FPL) (see OAR 461-155-0290) and the individual's total countable (see OAR 461-001-0000) income as follows: (a) For individuals with countable income less than 75 percent of the FPL, the participant fee is $0. (b) For individuals with countable income equal to or greater than 75 percent but less than 100 percent of the FPL, the participant fee is $50 per month. (c) For individuals with countable income equal to or greater than 100 percent but less than 250 percent of the FPL, the participant fee is $100 per month. (d) For individuals with countable income equal to or greater than 250 percent of the FPL, the participant fee is $150 per month. (3) The participant fee must be paid each month as a condition of eligibility for as long as the individual is receiving OSIP-EPD or OSIPM-EPD. (4) OSIP-EPD and OSIPM-EPD individuals in a licensed community-based care facility must pay room and board costs in addition to their participant fees. (5) The local office may waive unpaid participant fees if the individual provides verification (OAR 461-115-0610) of significant economic difficulty, such as, but not limited to, homelessness, divorce, domestic violence (see OAR 461-001-0000), or illness.